Percutaneous transthoracic needle biopsy for pulmonary nodules: a retrospective study of a comparison between C-arm cone-beam computed tomography and conventional computed tomography guidance

Abstract

Purpose: To evaluate the safety and diagnostic performance of pulmonary nodule biopsies using cone-beam computed tomography (CBCT) guidance compared with conventional CT (CCT) guidance. Material and methods: Patients who had pulmonary nodules and underwent a transthoracic needle biopsy at the interventional unit from January 1, 2013 to June 30, 2018 were enrolled. CBCT with XperGuide software was used to biopsy 100 nodules, and CCT guidance was used to biopsy 266 nodules. The two techniques were compared in terms of radiation exposure, complications, and diagnostic accuracy. The p values of less than 0.05 were considered statistically significant. Results: The characteristics of the nodules were similar between CBCT and CCT guidance. The median radiation doses were not significantly different between the two groups (5.6 mGy vs. 5.4 mGy; p = 0.78). All minor, major, and overall complications were insignificant (25% vs. 24.4%, 3% vs. 4.9% and 28% vs. 29.3%, respectively). Although CBCT guidance showed higher sensitivity and accuracy than CCT guidance (93.3% vs. 84.1% and 95.0% vs. 89.9%), both techniques had similar specificity (100% vs. 100%) in the diagnosis of malignancy. Conclusions: CBCT guidance in pulmonary nodule biopsy provided higher diagnostic sensitivity and accuracy than CCT guidance. However, the complication rates and effective radiation doses did not differ between both techniques.

Chinese expert consensus on cone‐beam CT‐guided diagnosis, localization and treatment for pulmonary nodules

“…Although CBCT is inferior to conventional CT in terms of imaging range and density resolution, in most cases it is sufficient to meet the clinical needs of guiding puncture and confirming the positional relationship of lesions and needle tips. Previous studies have showed that CBCT‐guided PTNB has a noninferior diagnostic accuracy for malignancy compared to conventional CT (94.9%–96.0% vs. 89.9%–95.3%) 69–71 . In comparison, conventional CT requires more room for the gantry frame and has a smaller inner space, which makes operations more challenging.…”

“…Previous studies have showed that CBCT‐guided PTNB has a noninferior diagnostic accuracy for malignancy compared to conventional CT (94.9%–96.0% vs. 89.9%–95.3%). 69 , 70 , 71 In comparison, conventional CT requires more room for the gantry frame and has a smaller inner space, which makes operations more challenging. Additionally, there is a higher chance of instrument displacement when patients are frequently moved in and out of the CT gantry for scanning and puncturing.…”