C-Arm Cone-Beam CT-Guided Transthoracic Lung Core Needle Biopsy as a Standard Diagnostic Tool

Abstract

C-arm cone-beam computed tomography (CT)-guided transthoracic lung core needle biopsy (CNB) is a safe and accurate procedure for the evaluation of patients with pulmonary nodules. This article will focus on the clinical features related to CNB in terms of diagnostic performance and complication rate. Moreover, the concept of categorizing pathological diagnosis into 4 categories, which could be used for clinical management, follow-up, and quality assurance is also introduced.We retrospectively collected data regarding 375 C-arm cone-beam CT-guided CNBs from January 2010 and June 2014. Clinical and radiological variables were evaluated in terms of success or failure rate. Pathological reports were inserted in 4 homogenous groups (nondiagnostic-L1, benign-L2, malignant not otherwise specified-L3, and malignant with specific histotype-L4), defining for each category a hierarchy of suggested actions.The sensitivity, specificity, and positive and negative predictive value and accuracy for patients subjected to CNBs were of 96.8%, 100%, 100%, 100%, and 97.2%, respectively. Roughly 75% of our samples were diagnosed as malignant, with 60% lung adenocarcinoma diagnoses. Molecular analyses were performed on 85 malignant samples to verify applicability of targeted therapy. The rate of “nondiagnostic” samples was 12%.C-arm cone-beam CT-guided transthoracic lung CNB can represent the gold standard for the diagnostic evaluation of pulmonary nodules. A clinical and pathological multidisciplinary evaluation of CNBs was needed in terms of integration of radiological, histological, and oncological data. This approach provided exceptional performances in terms of specificity, positive and negative predictive values; sensitivity in our series was lower compared with other large studies, probably due to the application of strong criteria of adequacy for CNBs (L1 class rate). The satisfactory rate of collected material was evaluated not only in terms of merely diagnostic performances but also for predictive results by molecular analysis.

A Systematic Review and Meta-Analysis of C-Arm Cone-Beam CT-Guided Percutaneous Transthoracic Needle Biopsy of Lung Nodules

“…The remaining 18 studies were evaluated by reading the full text. Of these, 7 were excluded because the subjects enrolled in these studies originated from the same institution or medical center [22–28]; 3 were excluded because of insufficient data to construct 2×2 tables of TP, FP, FN, and TN [29–31]. As a result, only 8 articles [14–21] were included in this meta-analysis, having met the inclusion criteria.…”

“…Among the interventional procedures, PTNB with CBCT has played an essential role in the diagnosis of patients with lung nodules since its introduction [13,35]. With respect to CBCT-guided PTNB, a foundation has already been laid [14–31], with a variety of clinical applications and ongoing investigations being performed using a CBCT system [36,37]. …”

“…The reported complications of CBCT-guided PTNB in the lungs include pneumothorax, hemorrhage, haemoptysis, chest pain, air embolism, procedure-related death and needle tract metastasis, among which the most common complications are pneumothorax and hemorrhage [14–31]. Fortunately, there were no severe complications such as air embolism, procedure-related death or needle tract metastasis in the eligible eight studies.…”

“…We realize that numerous studies have been published on the diagnostic accuracy of PTNB with the use of the CBCT system in patients with lung nodules [14–31]. However, there are no studies in which researchers have investigated the diagnostic accuracy of CBCT-guided PTNB by way of a systematic review or a meta-analysis.…”

The Role of Fine Needle Aspiration of Orbital Lesions: A Case Series

“…Lesion size, a common issue throughout all types of anatomical sites studied with cytology (i.e. thyroid [6] or lung nodules [7]), is surprisingly not a limiting factor of FNA performance, as our nondiagnostic rate also increased for smaller targets, especially those <20 mm in maximum diameter. Another variable that can affect the performance is the exact site of the radiological target, which can be superficial (lacrimal glands, tear ducts or eyelid) or deep into the orbital cavity, a location that can result in dislocation of the eye bulb.…”