Virtual Guidance of Percutaneous Transthoracic Needle Biopsy with C-Arm Cone-Beam CT: Diagnostic Accuracy, Risk Factors and Effective Radiation Dose

Fior, Davide; Vacirca, Francesco; Leni, Davide; Pagni, Fabio; Ippolito, Davide; Riva, Luca; Sironi, Sandro; Corso, Rocco

doi:10.1007/s00270-019-02163-3

Cited by 22 publications

(22 citation statements)

References 30 publications

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“…This could be due to the difficulty of the patients to maintain the necessary apneas during the advancement of the coaxial needle and the introduction and removal of the cutting needle. Other groups [18,20,25] have also reported a higher frequency of pneumothorax in patients in this position, although their studies have not detected significant differences. A larger size of the nodule seems to correspond to a lower possibility of suffering this complication.…”

Section: Discussionmentioning

confidence: 80%

Cone-Beam CT-Guided Lung Biopsies: Results in 94 Patients

et al. 2020

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Background: The aim of this study was to evaluate the diagnostic capacity of Cone-Beam computed tomography (CT)-guided transthoracic percutaneous biopsies on lung lesions in our setting and to detect risk factors for possible complications. Methods: Retrospective study of 98 biopsies in 94 patients, performed between May 2017 and January 2020. To obtain them, a 17G coaxial puncture system and a Siemens Artis Zee Floor vc21 archwire were used. Descriptive data of the patients, their position at the time of puncture, location and size of the lesions, number of cylinders extracted, and complications were recorded. Additionally, the fluoroscopy time used in each case, the doses/area and the estimated total doses received by the patients were recorded. Results: Technical success was 96.8%. A total of 87 (92.5%) malignant lesions and 3 (3.1%) benign lesions were diagnosed. The sensitivity was 91.5% and the specificity was 100%. We registered three technical failures and three false negatives initially. Complications included 38 (38.8%) pneumothorax and 2 (2%) hemoptysis cases. Fluoroscopy time used in each case was 4.99 min and the product of the dose area is 11,722.4 microGy/m2. Conclusion: The transthoracic biopsy performed with Cone-Beam CT is accurate and safe in expert hands for the diagnosis of lung lesions. Complications are rare and the radiation dose used was not excessive.

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Section: Discussionmentioning

confidence: 80%

Cone-Beam CT-Guided Lung Biopsies: Results in 94 Patients

et al. 2020

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“…Several attempts had been made to improve the puncture accuracy [8,9], but they didn't taken inevitable errors between actual operations and ideal presets into account. Herein, we compared the actual and planned puncture data.…”

Section: Discussionmentioning

confidence: 99%

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

Lin

Hong

Luo

et al. 2020

Preprint

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Background and purpose To evaluate the application of treatment planning system (TPS) assisted large-aperture computed tomography (CT) simulator in percutaneous biopsy, and report our initial experience of the accuracy and safety of this procedure.Methods From November 2018 to December 2019, treatment planning system assisted large-aperture CT simulator guided percutaneous biopsy was performed on 38 cases, with 34 of percutaneous lung biopsy, three of abdominal lesions biopsy, and one case of deep supraclavicular lymph node biopsy. The major results including planned and actual puncture parameters, the success rate, pathological information and complications were recorded. The analyses of puncture accuracy were accomplished by pared-t test and Wilcoxon rank sum test. And the risk factors of puncture accuracy and complications were further identified.Results The entire cohort achieved one-time success of biopsy. No significant differences were presented between planned and actual puncture depth and direction (P = 0.436 and 0.382), indicating the precision of the process. And the pulmonary puncture location was related to the accuracy of puncture direction (P = 0.033). Biopsy specimens were successfully obtained in 38 cases. The diagnostic rate of malignancy was 76%, of which 80% for initial treatment group and 69% for treated group, respectively. For patients with pulmonary biopsy, 12 had minor pneumothorax and 2 progressed to massive pneumothorax. Only three cases suffered needle track bleeding, and no other complications were observed. Additionally, the regression analysis found a significant correlation between puncture angle and the incidence of pneumothorax (P = 0.027).Conclusions TPS assisted large-aperture CT simulator improved the procedure of percutaneous biopsy by combining the advantages of radiotherapy specialty. The initial results suggested the increase of puncture accuracy and success rate, with satisfactory safety simultaneously. It might offer new insights into the field of CT-guided percutaneous biopsy.

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“…procedures allowed its requirement : 5 of 24 20.8 were in the 2 nd to the 3 rd intercostal spaces, 11 of 45 24.4 were in 4 th to the 7 th intercostal spaces, and 19 of 44 43. 2 were in the 8 th to the 11 th intercostal spaces. Despite these technical parameters, hemothorax occurred in only two procedures, and the remaining 111 of 113 98.2 procedures did not cause hemothorax.…”

Section: Discussionmentioning

confidence: 99%

“…Computed tomography CT -guided percutaneous transthoracic lung biopsy TLB is a well-established, minimally invasive technique used to characterize pulmonary lesions that are suspicious of malignancy and inaccessible by bronchoscopy 1 . This procedure is conventionally performed with CT uoroscopy and CT-guidance, and it has achieved a high-diagnostic accuracy 90 and increased sensitivity and speci city both 95 in diagnosing malignancies 2 . C-arm cone-beam CT CBCT was introduced recently because the CBCT system enables both uoroscopic and CT-guidance using a cone-beam X-ray tube and a at-panel detector 3 , wherein CBCT-guided TLB procedures can yield similar diagnostic accuracy and complications to CT-uoroscopic biopsies 4 5 .…”

Section: Introductionmentioning

confidence: 99%

C-arm Cone-beam CT-guided Needle Biopsies through the Erector Spinal Muscle for Posterior Thoracic Pulmonary Lesions

Takeyama

Hashimoto

Kotake

et al. 2020

Showa Univ J Med Sci

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This study investigated retrospectively the diagnostic yield and complication rate of transthoracic needle biopsies for posterior thoracic pulmonary lesions using C-arm cone-beam computed tomography CBCT. The risk factors for pulmonary hemorrhage were evaluated. Our study included 113 patients with 113 posterior pulmonary lesions mean longest diameter: 30.6 mm, and mean depth: 4.7 mm through the erector spinal muscles using a 19 / 20-gauge coaxial system. The diagnostic performances of procedures for malignant lesions and the incidence of complications after biopsies were also assessed. The patient-related and procedure-related variables were investigated. Risk factors for pulmonary hemorrhage were analyzed with a multivariate logistic regression analysis. Findings revealed 99 malignant, 13 benign, and one intermediate lesion. Sensitivity, speci city, and diagnostic accuracy rates were 100 99 / 99 , 92.3 12 / 13 , and 99.1 111 / 112 , respectively. Air embolization, hemothorax, hemoptysis, pneumothorax, and pulmonary hemorrhage, occurred in 0, 2, 12, 48, and 70 procedures. The averaged spinous process-pleura depth and the traversed lung parenchyma depth achieved by the introducer needles were 54.2 mm and 27.4 mm, respectively. The needle position at the pleural puncture site within the intercostal space was in middle 31 and inferior 69 areas. The incidence of pulmonary hemorrhage was significantly higher in smaller lesions p 0.001. Manual evacuation was performed in ve procedures for patients with pneumothorax. The chest tube placement trocar 8 Fr was performed in two procedures in patients with hemothorax and pneumothorax. In conclusion, the biopsy method with a posterior intercostal approach for posterior thoracic pulmonary lesions yielded high diagnostic accuracy and few major complications.

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Virtual Guidance of Percutaneous Transthoracic Needle Biopsy with C-Arm Cone-Beam CT: Diagnostic Accuracy, Risk Factors and Effective Radiation Dose

Cited by 22 publications

References 30 publications

Cone-Beam CT-Guided Lung Biopsies: Results in 94 Patients

Cone-Beam CT-Guided Lung Biopsies: Results in 94 Patients

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

C-arm Cone-beam CT-guided Needle Biopsies through the Erector Spinal Muscle for Posterior Thoracic Pulmonary Lesions

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