CT fluoroscopy-guided lung biopsy versus conventional CT-guided lung biopsy: a prospective controlled study to assess radiation doses and diagnostic performance

Abstract

CT fluoroscopy-guided NAB of pulmonary lesions provides high diagnostic accuracy and can be performed with significantly fewer complications. However, radiation exposure to both patient and doctor were significantly higher than conventional CT-guided NAB.

Intrathoracic tumors in contact with the chest wall – ultrasonographic and computed tomography guided biopsy comparative evaluation

“…In our series, we found three cases in which post-procedual CT showed a thin blood layer around the lesion. Adequacy rate of peripheral pulmonary or pleural lesion biopsy performed with a non fine needle is reported to be between 89.5% and 97% with CT guidance (6,9,10,23) and between 76%and 96 % with US guidance (17,19,20). Our values are comparable with those reported in the literature.…”

“…These complications can increase patient discomfort , as well as the length of time during which the needle is positioned across the pleura . The introduction of CT fluoroscopy has overcome the limitation of real-time needle visualization during CT-guided procedures, but it still provides only transverse sections and introduces a substantial amount of radiation exposure to both patient and operator (6).…”

“…Percutaneous biopsy has also been used to obtain tissue for genetic and immunologic testing of cancer mutations, thus improving the care of patients undergoing targeted chemotherapy (2,3). Imaging -guided percutaneous trans-thoracic biopsy has become a widely accepted , effective, and safe minimally invasive technique with which to obtain tissue specimens from a number of different intra-thoracic lesions (4)(5)(6) .…”

“…To overcome these limits, CT fluoroscopy has been introduced recently. This tool allows for continuous monitoring of both lung movements and needle course as it progresses toward the lesion (9-11) however , both of these imaging modalities use a large amount of ionizing radiation and are capable of providing only axial sections of the lung in real time (6,12). In the chest, the role of ultrasonography (US) has traditionally been limited when compared with CT, since US waves are not able to penetrate aerated tissue (13).…”

Adequacy of Transthoracic Needle Biopsy Samples in the Diagnosis of a Peripheral Lung Lesion – Comparing Success Rates of Various Imaging Modalities

“…A report by Manhire et al suggested that within TTNA, no association exists between complication rates and needle type and size [13]. TTNA has diagnostic yields of greater than 90%, which is higher than any other non-surgical approach [14] Other viable diagnostic options for indeterminate pulmonary lesions such as flexible bronchoscopy and its ancillary procedures have lower success rates ranging from (14-63%). [15] The disadvantages of TTNA however, are very high rates of pneumothorax (ranging between15-25%) while other bronchoscopic approaches have much lower rates (~1.5%).…”