CT-Guided Percutaneous Transthoracic Needle Biopsy Using the Additional Laser Guidance System by a Pulmonologist with 2 Years of Experience in CT-Guided Percutaneous Transthoracic Needle Biopsy

Abstract

BackgroundWe developed an additional laser guidance system to improve the efficacy and safety of conventional computed tomography (CT)–guided percutaneous transthoracic needle biopsy (PTNB), and we conducted this study to evaluate the efficacy and safety of our system.MethodsWe retrospectively analyzed the medical records of 244 patients who underwent CT-guided PTNB using our additional laser guidance system from July 1, 2015, to January 20, 2016.ResultsThere were nine false-negative results among the 238 total cases. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of our system for diagnosing malignancy were 94.4% (152/161), 100% (77/77), 100% (152/152), 89.5% (77/86), and 96.2% (229/238), respectively. The results of univariate analysis showed that the risk factors for a false-negative result were male sex (p=0.029), a final diagnosis of malignancy (p=0.033), a lesion in the lower lobe (p=0.035), shorter distance from the skin to the target lesion (p=0.003), and shorter distance from the pleura to the target lesion (p=0.006). The overall complication rate was 30.5% (74/243). Pneumothorax, hemoptysis, and hemothorax occurred in 21.8% (53/243), 9.1% (22/243), and 1.6% (4/243) of cases, respectively.ConclusionThe additional laser guidance system might be a highly economical and efficient method to improve the diagnostic efficacy and safety of conventional CT-guided PTNB even if performed by inexperienced pulmonologists.

Initial Experience in CT-Guided Percutaneous Transthoracic Needle Biopsy of Lung Lesions Performed by a Pulmonologist

“…As this complicates targeting the lung lesion and may require abandoning the procedure, the result in such cases may be diagnostic failure. Unlike previous studies, we did not find an association between diagnostic failure and male sex, lower lobe location, number of specimens, or a final diagnosis of malignancy [19,23].…”

“…Several studies have assessed the feasibility and safety of ultrasound-assisted transthoracic biopsy when performed by a pulmonologist [12,13,14,15]. The diagnostic efficacy and safety of CT-guided PTNB using a laser guidance system, performed by a pulmonologist with 2 years of experience in CT-guided PTNB, have also been demonstrated [19]. However, the safety and outcome of CT-guided PTNB performed by an inexperienced pulmonologist had not previously been determined.…”

Transthoracic Needle Biopsy: How to Maximize Diagnostic Accuracy and Minimize Complications

“…It allows to determine the skin puncture site, needle insertion angle, and confirm the needle tip placement. It has been used since the 1980s, and recently published studies showed excellent diagnostic accuracy (96.1%–96.7%) which is comparable to other latest modalities [ 10 - 12 ]. Even the results of CCT-guided TTNB for lesions smaller than 1 cm or ground glass nodule (GGN) showed more than 90% diagnostic accuracy [ 13 ].…”

“…It has been used since the 1980s, and recently published studies showed excellent diagnostic accuracy (96.1~96.7%) which is comparable to other latest modalities. [10][11][12][13] Even the results of CCT-guided TTNB for lesions smaller than 1 cm or GGN showed more than 90% diagnostic accuracy. 14 However, there are technical difficulties in patients with large respiratory motion or inability to breathe coordinately due to lack of real-time capability.…”

Recent advances in diagnostic technologies in lung cancer

“…Park HJ, et al Diagnostic tools in lung cancer technique including the addition of laser guidance to improve its accuracy and reduce the risk of complications [26].…”