Transthoracic fine-needle aspiration biopsy of the lungs using a C-arm cone-beam CT system: diagnostic accuracy and post-procedural complications

Abstract

Objective: The purpose of our study was to evaluate the diagnostic accuracy of transthoracic fine-needle aspiration biopsy (TFNAB) using a C-arm cone-beam CT (CBCT) system and to assess risk factors for immediate post-procedural complications in patients with lung lesions. Methods: From October 2007 to April 2009, 94 TFNAB procedures using a C-arm system were studied in 91 patients with pulmonary lesions a chest CT scans. We retrospectively reviewed the patients' radiological and histopathological findings. We evaluated the lesion size, lesion abutted to pleura and presence or absence of emphysema along the needle path, lesion depth, visibility of target lesion and patient's position. Pneumothorax and pulmonary haemorrhage were assessed after TFNAB. Overall diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were analysed. Results: In 94 TFNAB procedures, 58 lesions were malignant and 36 were benign. The sensitivity, specificity, PPV, NPV and overall diagnostic accuracy rate of TFNAB were 93.1%, 100%, 100%, 90% and 97.9%, respectively. Pneumothorax was developed in 24 procedures. None of the parameters showed significant impact on the frequency of the pneumothorax. Overall haemorrhage occurred in 43 procedures. The incidence of overall haemorrhage was higher in patients with smaller lesions, longer pleural distance and pleural abutted lesions (p,0.05). Differences in visibility at projection radiographs were statistically significant between patients with or without perilesional haemorrhage (p,0.05). Conclusion: Transthoracic fine-needle aspiration biopsy using a C-arm CBCT system is feasible for imaging guidance of lung lesion and early detection of the proceduralrelated complications.

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

“…Seven of the studies [14,16–21] were retrospective whereas one study [15] was prospective. Of these, 4 studies [14,16–28] were conducted in different medical institutions in South Korea, whereas the other 4 studies [15,19–21] were conducted in different institutions all over the world. Information about the technical statements of PTNB using CBCT and other basic descriptions of the 8 articles involved in this systematic review and meta-analysis are listed in Table 1.…”

“…The selection of a biopsy procedure with a low radiation dose is important for patient’s safety. From our data extraction, it was revealed that an effective dose for CBCT-guided PTNB had been reported in all of the studies [14,15,17–21] except for the study conducted by Lee et al [16]. The reported mean estimated effective patient radiation dose ranged between 4.6–14.3 mSv (mean, 7.34 mSv) [14,18–21].…”

Cone beam CT guidance provides superior accuracy for complex needle paths compared with CT guidance

“…Braak et al [8] described the effective patient dose of CBCT guidance procedures to be reduced by 13-42% compared with CT guidance for abdominal and thoracic procedures. Other authors reported diagnostic accuracies of CBCT guidance to be comparable to or higher than other guidance modalities [14][15][16][20][21][22]. However, until now, the accuracy of CBCT guidance for reaching small (millimetre-sized) targets has not been addressed specifically.…”

The Society for Translational Medicine: indications and methods of percutaneous transthoracic needle biopsy for diagnosis of lung cancer

“…After the procedure, the patient has bed rest and avoid vigorous physical activity for the first 24 hours. The most frequently reported complications include: (I) Pneumothorax (5,(46)(47)(48)(49)(50)(51)(52)(53)(54)(55)(56)(57)(58)(59): pneumothorax is the most common complication. A small pneumothorax may spontaneously resolve without any treatment.…”