Transthoracic Computed Tomography-Guided Lung Biopsy in the New Era of Personalized Medicine

Abstract

Computed tomography-guided lung biopsy is a valid and safe procedure for characterizing pulmonary nodules. In the past years, this technique has been mainly used to confirm the malignant nature of undetermined pulmonary lesions; however, today its role has been completely renewed. With the advent of target therapy and immunotherapy, it has arisen for lung cancer, in inoperable patients, the necessity to obtain adequate bioptical material to perform a correct molecular characterization of the lesion. Moreover, the possibility of acquired drug-resistance mechanisms makes it necessary in some cases to rebiopsy these lesions over time. For these reasons, it is likely that the request of computed tomography-guided lung biopsy will increase in the future, therefore every radiologist should be confident with its most important aspects.

Application of a treatment planning system-assisted large-aperture computed tomography simulator to percutaneous biopsy: initial experience of a radiation therapist

“…In the era of individualized precision treatment, especially with the advancements in molecular targeted therapy and immunotherapy, pathology is still a prerequisite for further gene detection, exploration of drug resistance mechanisms and evaluation of patient conditions. [8][9][10] CT-guided percutaneous biopsy, as an important solution for the acquisition of pathological information, is playing an increasingly critical role in clinical practice, 11 which requires improved operability and accuracy. Unfortunately, there still exists defects in this process in terms of inaccurate positioning, low one-time success rate, heterogeneity of operators' experience and the poor compliance of some patients who are prone to serious complications.…”

Computed tomography guided lung biopsy under general anaesthesia with apnoea: Preliminary experience

“…This is also lower than overall literature rates of~40%, and chest tube insertion in the GA group was 5.5% which is within literature range of up to 7%. 2,3,8,9,13 In the GA patient who required a chest tube, it is felt there was inadvertent positive pressure ventilation prior to the introducer needle being withdrawn and CT at 2 min post-needle withdrawal showed pneumothorax occupying a third of the hemithorax. The rate of peri-lesion haemorrhage was 33% in GA patients, also within literature quoted ranges (up to 40%) and similar to the control group (30%).…”

“…The rate of peri-lesion haemorrhage was 33% in GA patients, also within literature quoted ranges (up to 40%) and similar to the control group (30%). 3,8,10,12 This technique allows histological diagnosis of lesions which are difficult to access or due to patient factors, conventional CTPLB cannot be performed. Thus, GA-assisted biopsy allows safe access to lesions previously deemed unsafe to biopsy or where conventional sampling failed.…”

“…Computed tomography guided percutaneous lung biopsy (CTPLB) is a fundamental tool in the management of primary lung malignancy and confirming histology of pulmonary nodules in patients with extra-pulmonary malignancy. [1][2][3][4][5] Due to increased CT sensitivity in detecting subcentimetre nodules and updated Fleischner Society guidelines, there is greater impetus to biopsy smaller lesions. 6 However, the rate of non-diagnostic histological results, risk of pneumothorax and haemorrhage increase with decreasing lesion size (particularly <20 mm).…”

Application of treatment planning system assisted large-aperture computed tomography simulator in percutaneous biopsy: initial experience by a radiation therapist

“…In the era of individualized precision treatment, especially with the advancement of molecular targeted therapy and immunotherapy, pathology is prerequisite for further gene detection, exploration of drug resistance mechanisms, and evaluation of patients' conditions [4][5][6]. CT-guided percutaneous biopsy, as one of the important solution for pathological information acquisition, is playing a more critical role in clinical practice [7], which requires better operability and accuracy. Yet, there still exist defect in inaccurate positioning, low one-time success rate, heterogeneity of operators' experience, and the poor compliance of some patients who are prone to serious complications.…”