scholarly journals C-Arm Cone-Beam CT Virtual Navigation Versus Conventional CT Guidance in the Transthoracic Lung Biopsy: A Case-Control Study

Diagnostics ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. 115
Author(s):  
Lian Yang ◽  
Yue Wang ◽  
Lin Li ◽  
Dehan Liu ◽  
Xin Wu ◽  
...  

C-arm cone-beam computed tomography (CBCT) virtual navigation-guided lung biopsy has been developed in the last decade as an alternative to conventional CT-guided lung biopsy. This study aims to compare the biopsy accuracy and safety between these two techniques and explores the risk factors of biopsy-related complications. A total of 217 consecutive patients undergoing conventional CT- or C-arm CBCT virtual navigation-guided lung biopsy from 1 June 2018 to 31 December 2019 in this single-center were retrospectively reviewed. Multiple factors (e.g., prior emphysema, lesion size, etc.) were compared between two biopsy techniques. The risk factors of complications were explored by using logistic regression. The patients’ median age and male-to-female ratio were 63 years and 2.1:1, respectively. Eighty-two (82) patients (37.8%) underwent conventional CT-guided biopsies, and the other 135 patients (62.2%) C-arm CBCT virtual navigation-guided biopsies. Compared with patients undergoing C-arm CBCT virtual navigation-guided lung biopsies, patients undergoing conventional CT-guided lung biopsies showed higher needle repositioning rate, longer operation time, and higher effective dose of X-ray (52.4% vs. 6.7%, 25 min vs. 15 min, and 13.4 mSv vs. 7.6 mSv, respectively; p < 0.001, each). In total, the accurate biopsy was achieved in 215 of 217 patients (99.1%), without a significant difference between the two biopsy techniques (p = 1.000). The overall complication rates, including pneumothorax and pulmonary hemorrhage/hemoptysis, are 26.3% (57/217), with most minor complications (56/57, 98.2%). The needle repositioning was the only independent risk factor of complications with an odds ratio of 6.169 (p < 0.001). In conclusion, the C-arm CBCT virtual navigation is better in percutaneous lung biopsy than conventional CT guidance, facilitating needle positioning and reducing radiation exposure. Needle repositioning should be avoided because it brings about more biopsy-related complications.

2015 ◽  
Vol 8 (4) ◽  
pp. 258-264 ◽  
Author(s):  
Yun-Chung Cheng ◽  
Sheng-Heng Tsai ◽  
Yuchi Cheng ◽  
Jeon-Hor Chen ◽  
Jyh-Wen Chai ◽  
...  

Author(s):  
Rémi Grange ◽  
Robin Sarkissian ◽  
Sophie Bayle-Bleuez ◽  
Claire Tissot ◽  
Olivier Tiffet ◽  
...  

Objective: To evaluate the clinical impact of the tract embolization technique using gelatin sponge slurry after percutaneous CT-guided lung biopsy. Methods: We retrospectively compared coaxial needle CT-guided lung biopsies performed without embolization (100 patients) and with the tract embolization technique using a mixture of iodine and gelatin sponge slurry (105 patients) between June 2012 and July 2020. Uni- and multivariate analyses were performed between groups to determine risk factors of pneumothorax. Results: Patients with gelatin sponge slurry tract embolization had statistically lower rates of pneumothorax ((17.1% vs 39%, p < 0.001). In univariate analysis, tract embolization (OR = 0.32, CI = 0.17–0.61 p<0.001) and nodule size >2 cm (OR = 0.33 CI = 0.14–0.8 p = 0.013) had a protective effect on pneumothorax. The puncture path lengths > 2–20 mm and >20 mm were risk factors for pneumothorax (OR = 3.35 IC = 1.44–8.21 p = 0.006 and OR = 4.36 CI = 1.98–10.29 p<0.001, respectively). In multivariate regression analysis, tract embolization had a protective effect of pneumothorax (OR = 0.25, CI = 0.12–0.51, p < 0.001). The puncture path lengths > 2–20 mm and >20 mm were risk factors for pneumothorax (p = 0.030 and p = 0.002, respectively). Conclusions: The tract embolization technique using iodinated gelatin sponge slurry is safe and considerably reduces pneumothorax after percutaneous CT-guided lung biopsy. Our results suggest that it could be use in clinical routine. Advances in knowledge: The systemic use of gelatin sponge slurry is safe and reduces considerably the rate of pneumothorax upon needle removal when CT-guided core biopsies are performed using large 16–18G coaxial needles.


2008 ◽  
Vol 49 (8) ◽  
pp. 876-882 ◽  
Author(s):  
L. A. Kurban ◽  
L. Gomersall ◽  
J. Weir ◽  
P. Wade

Background: Computed tomography (CT) fluoroscopy nowadays is the most preferred method of guidance to perform percutaneous lung biopsy of pulmonary masses. Conventional fluoroscopy is an increasingly forgotten technique that still can be used to perform lung biopsies, with many advantages. Purpose: To compare the accuracy, safety, and effective dose (ED) of conventional fluoroscopy-guided needle lung biopsy (FNLB) with CT-guided needle lung biopsy procedures (CTNLB) reported in the literature. Material and Methods: 100 consecutive patients who underwent FNLB were reviewed retrospectively. Using the final histological diagnoses and the clinical and radiological course of the disease as references, the accuracy and sensitivity of FNLB were calculated. The complication rates of FNLB were assessed. Using computer software (XDOSE), the ED was calculated. The accuracy, complication rates, and the ED of FNLB were compared with CTNLB reported in the literature. Results: The overall accuracy rate and sensitivity of FNLB were both 87%, which are comparable to the range of accuracies reported in the literature for CTNLB (74–97%). The complication rates of FNLB were also comparable to the complication rates reported for CTNLB. The commonest complication was pneumothorax, at a rate of 25%. The ED of FNLB was small, significantly lower than reported in the literature for CT-guided procedures. The mean ED of FNLB was 0.029 mSv, which is approximately equivalent to one chest X-ray. Conclusion: Conventional fluoroscopy is an accurate, safe, and low-dose alternative modality to CT to obtain an image-guided histological diagnosis of pulmonary lesions.


2017 ◽  
Vol 45 (6) ◽  
pp. 2101-2109 ◽  
Author(s):  
Barbara K Frisch ◽  
Karin Slebocki ◽  
Kamal Mammadov ◽  
Michael Puesken ◽  
Ingrid Becker ◽  
...  

Objective To evaluate the use of ultra-low-dose computed tomography (ULDCT) for CT-guided lung biopsy versus standard-dose CT (SDCT). Methods CT-guided lung biopsies from 115 patients (50 ULDCT, 65 SDCT) were analyzed retrospectively. SDCT settings were 120 kVp with automatic mAs modulation. ULDCT settings were 80 kVp with fixed exposure (20 mAs). Two radiologists evaluated image quality (i.e., needle artifacts, lesion contouring, vessel recognition, visibility of interlobar fissures). Complications and histological results were also evaluated. Results ULDCT was considered feasible for all lung interventions, showing the same diagnostic accuracy as SDCT. Its mean total radiation dose (dose–length product) was significantly reduced to 34 mGy-cm (SDCT 426 mGy-cm). Image quality and complication rates ( P = 0.469) were consistent. Conclusions ULDCT for CT-guided lung biopsies appears safe and accurate, with a significantly reduced radiation dose. We therefore recommend routine clinical use of ULDCT for the benefit of patients and interventionalists.


2017 ◽  
Vol 103 (4) ◽  
pp. 360-366 ◽  
Author(s):  
Alfonso Vittorio Marchianò ◽  
Maria Cosentino ◽  
Giuseppe Di Tolla ◽  
Francesca Gabriella Greco ◽  
Mario Silva ◽  
...  

Purpose To evaluate the diagnostic yield and complication rate of 2 different biopsy techniques (fine-needle aspiration, FNA, and core-needle biopsy, CNB) in the diagnosis of pulmonary lesions in 2 distinct periods, 2010-2012 and 2013-2015. Methods We retrospectively analyzed the results of 691 CT-guided lung biopsies in 665 patients who were divided into 2 groups: cohort 1 (January 2010 to December 2012) was composed of 271 consecutive patients with 284 procedures either by FNA or CNB; cohort 2 (January 2013 to December 2015) was composed of 394 patients with 407 CNBs. Univariate and multivariate logistic regression modeling was used for selected outcomes including diagnostic yield, bleeding and pneumothorax. Results Cohort 1 comprised 165 men and 106 women (mean age 68.5 years) with 180 FNAs and 104 CNBs; cohort 2 comprised 229 men and 165 women (mean age 66.4 years) with 407 CNBs. The diagnostic yield increased in cohort 2 with respect to cohort 1. There was a slight increase in CT procedure complications (pneumothorax and bleeding) from cohort 1 to cohort 2. The overall risk of complications was greater for lesions <20 mm and for lesions at >20 mm distance from the pleura. Conclusions CT-guided CNB had a higher diagnostic yield than discretional use of either FNA or CNB; there was a slight but acceptable increase in complication rates.


2020 ◽  
pp. 028418512091762
Author(s):  
Ting Liang ◽  
Yonghao Du ◽  
Chenguang Guo ◽  
Yuan Wang ◽  
Jin Shang ◽  
...  

Background Computed tomography (CT)-guided percutaneous lung biopsy is usually performed by helical scanning. However, there are no studies on radiation dose, diagnostic accuracy, image quality, and complications based on axial scan mode. Purpose To determine radiation dose, accuracy, image quality, and complication rate following an ultra-low-dose (ULD) protocol for CT-guided lung biopsy in clinic. Material and Methods A total of 105 patients were enrolled to receive CT-guided lung biopsy. The use of an ULD protocol (axial scan) for CT-guided biopsy was initiated. Patients were randomly assigned to axial mode (Group A) and conventional helical mode (Group B) CT groups. 64-slice CT was performed for CT-guided pulmonary biopsy with an 18-G coaxial cutting biopsy needle. The radiation dose, accuracy, image quality, and complication rate were measured. Results Ninety-seven patients were selected for the final phase of the study. There was no significant difference between the two groups for pulmonary nodule characteristics ( P > 0.05). The mean effective dose in group A (0.077 ± 0.010 mSv) was significantly reduced relative to group B (0.653 ± 0.177 mSv, P < 0.001). There was no significant difference in accuracy, image quality, and complication rate ( P > 0.050) between the two modes. Conclusion An ULD protocol for CT-guided lung nodule biopsy yields a reduction in the radiation dose without significant change in the accuracy, image quality, and complication rate relative to the conventional helical mode scan.


2020 ◽  
Vol 93 (1108) ◽  
pp. 20190866 ◽  
Author(s):  
Ya Ruth Huo ◽  
Michael Vinchill Chan ◽  
Al-Rahim Habib ◽  
Isaac Lui ◽  
Lloyd Ridley

Objective: This systematic review and meta-analysis investigated risk factors for pneumothorax following CT-guided percutaneous transthoracic lung biopsy. Methods: A systematic search of nine literature databases between inception to September 2019 for eligible studies was performed. Results: 36 articles were included with 23,104 patients. The overall pooled incidence for pneumothorax was 25.9% and chest drain insertion was 6.9%. Pneumothorax risk was significantly reduced in the lateral decubitus position where the biopsied lung was dependent compared to a prone or supine position [odds ratio (OR):3.15]. In contrast, pneumothorax rates were significantly increased in the lateral decubitus position where the biopsied lung was non-dependent compared to supine (OR:2.28) or prone position (OR:3.20). Other risk factors for pneumothorax included puncture site up compared to down through a purpose-built biopsy window in the CT table (OR:4.79), larger calibre guide/needles (≤18G vs >18G: OR 1.55), fissure crossed (OR:3.75), bulla crossed (OR:6.13), multiple pleural punctures (>1 vs 1: OR:2.43), multiple non-coaxial tissue sample (>1 vs 1: OR 1.99), emphysematous lungs (OR:3.33), smaller lesions (<4 cm vs 4 cm: OR:2.09), lesions without pleural contact (OR:1.73) and deeper lesions (≥3 cm vs <3cm: OR:2.38). Conclusion: This meta-analysis quantifies factors that alter pneumothorax rates, particularly with patient positioning, when planning and performing a CT-guided lung biopsy to reduce pneumothorax rates. Advances in knowledge: Positioning patients in lateral decubitus with the biopsied lung dependent, puncture site down with a biopsy window in the CT table, using smaller calibre needles and using coaxial technique if multiple samples are needed are associated with a reduced incidence of pneumothorax.


2017 ◽  
Vol 28 (2) ◽  
pp. S110
Author(s):  
K Harper ◽  
H Al-Dujaili ◽  
B Mussari ◽  
A Nasirzadeh ◽  
A Menard

2017 ◽  
Vol 122 (8) ◽  
pp. 557-563 ◽  
Author(s):  
Dechao Jiao ◽  
Zongming Li ◽  
Zhiguo Li ◽  
Shaofeng Shui ◽  
Xin-wei Han

2021 ◽  
Vol 5 ◽  
pp. 14
Author(s):  
Matthew Wilson ◽  
Adib R. Karam ◽  
Grayson L. Baird ◽  
Michael S. Furman ◽  
David J. Grand

Objectives: The aim of this retrospective study was to investigate the relationship between lung lesion lobar distribution, lesion size, and lung biopsy diagnostic yield. Material and Methods: This retrospective study was performed between January 1, 2013, and April 30, 2019, on CT-guided percutaneous transthoracic needle biopsies of 1522 lung lesions, median size 3.65 cm (range: 0.5– 15.5 cm). Lung lesions were localized as follows: upper lobes, right middle lobe and lingual, lower lobes superior segments, and lower lobes basal segments. Biopsies were classified as either diagnostic or non-diagnostic based on final cytology and/or pathology reports. Results were considered diagnostic if malignancy or a specific benign diagnosis was established, whereas atypical cells, non-specific benignity, or insufficient specimen were considered non-diagnostic. Results: The positive predictive value (PPV) of a diagnostic yield was 85%, regardless of lobar distribution. Because all PPVs were relatively high across locations (84–87%), we failed to find statistically significant difference in PPV between locations (P = 0.79). Furthermore, for every 1 cm increase in target size, the odds of a diagnostic yield increased by 1.42-fold or 42% above 85%. Although target size increased the diagnostic yield differently by location (between 1.4- and 1.8-fold across locations), these differences failed to be statistically significant, P = 0.55. Conclusion: Percutaneous transthoracic needle biopsy of lung lesions achieved high diagnostic yield (PPV: 84– 87%) across all lobes. A 42% odds increase in yield was achieved for every 1 cm increase in target size. However, this increase in size failed to be statistically significant between lobes.


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