Korean J Radiol.  2011 Feb;12(1):89-96. 10.3348/kjr.2011.12.1.89.

Combined Fluoroscopy- and CT-Guided Transthoracic Needle Biopsy Using a C-Arm Cone-Beam CT System: Comparison with Fluoroscopy-Guided Biopsy

• Cheung JY
• Kim Y
• Shim SS
• Lim SM

• KMID: 991686
• DOI: http://doi.org/10.3348/kjr.2011.12.1.89

Abstract

OBJECTIVE
The aim of this study was to evaluate the usefulness of combined fluoroscopy- and CT-guided transthoracic needle biopsy (FC-TNB) using a cone beam CT system in comparison to fluoroscopy-guided TNB (F-TNB).
MATERIALS AND METHODS
We retrospectively evaluated 74 FC-TNB cases (group A) and 97 F-TNB cases (group B) to compare their respective diagnostic accuracies according to the size and depth of the lesion, as well as complications, procedure time, and radiation dose.
RESULTS
The sensitivity for malignancy and diagnostic accuracy for small (< 30 mm in size) and deep (> or = 50 mm in depth) lesions were higher in group A (91% and 94%, 92% and 94%) than in group B (73% and 81%, 84% and 88%), however not statistically significant (p > 0.05). Concerning lesions > or = 30 mm in size and < 50 mm in depth, both groups displayed similar results (group A, 91% and 92%, 80% and 87%; group B, 90% and 92%, 86% and 90%). Pneumothorax occurred 26% of the time in group A and 14% for group B. The mean procedure time and patient skin dose were significantly higher in group A (13.6 +/- 4.0 minutes, 157.1 +/- 76.5 mGy) than in group B (9.0 +/- 3.5 minutes, 21.9 +/- 15.2 mGy) (p < 0.05).
CONCLUSION
Combined fluoroscopy- and CT-guided TNB allows the biopsy of small (< 30 mm) and deep lesions (> or = 50 mm) with high diagnostic accuracy and short procedure times, whereas F-TNB is still a useful method for large and superficial lesions with a low radiation dose.

Keyword

Biopsy; Cone beam CT; Fluoroscopy; Lung

MeSH Terms

Adult
Aged
Aged, 80 and over
*Biopsy, Fine-Needle
*Cone-Beam Computed Tomography
Female
*Fluoroscopy
Humans
Lung/*pathology
Lung Neoplasms/pathology
Male
Middle Aged
*Radiography, Interventional
Sensitivity and Specificity

Figure

• 

  Fig. 1 Combined fluoroscopy- and CT-guided transthoracic needle biopsy technique using C-arm cone beam CT system. A. For first step, metallic line marker was attached to patient's skin, covering anticipated entrance point of needle, under fluoroscopy guidance. B. CT scan was performed, and exact entrance point and puncture depth of needle were determined based on analysis of multiplanar reformation images on computer workstation. C. Last step involved transthoracic needle biopsy under fluoroscopy guidance.

Reference

1. Heck SL, Blom P, Berstad A. Accuracy and complications in computed tomography fluoroscopy-guided needle biopsies of lung masses. Eur Radiol. 2006. 16:1387–1392.

2. Ohno Y, Hatabu H, Takenaka D, Higashino T, Watanabe H, Ohbayashi C, et al. CT-guided transthoracic needle aspiration biopsy of small (< or = 20 mm) solitary pulmonary nodules. AJR Am J Roentgenol. 2003. 180:1665–1669.

3. Li H, Boiselle PM, Shepard JO, Trotman-Dickenson B, McLoud TC. Diagnostic accuracy and safety of CT-guided percutaneous needle aspiration biopsy of the lung: comparison of small and large pulmonary nodules. AJR Am J Roentgenol. 1996. 167:105–109.

4. Westcott JL. Direct percutaneous needle aspiration of localized pulmonary lesions: result in 422 patients. Radiology. 1980. 137:31–35.

5. vanSonnenberg E, Casola G, Ho M, Neff CC, Varney RR, Wittich GR, et al. Difficult thoracic lesions: CT-guided biopsy experience in 150 cases. Radiology. 1988. 167:457–461.

6. Gupta R, Cheung AC, Bartling SH, Lisauskas J, Grasruck M, Leidecker C, et al. Flat-panel volume CT: fundamental principles, technology, and applications. Radiographics. 2008. 28:2009–2022.

7. Aviram G, Schwartz DS, Meirsdorf S, Rosen G, Greif J, Graif M. Transthoracic needle biopsy of lung masses: a survey of techniques. Clin Radiol. 2005. 60:370–374.

8. Geraghty PR, Kee ST, McFarlane G, Razavi MK, Sze DY, Dake MD. CT-guided transthoracic needle aspiration biopsy of pulmonary nodules: needle size and pneumothorax rate. Radiology. 2003. 229:475–481.

9. Haaga JR, Reich NE, Havrilla TR, Alfidi RJ, Meaney TF. CT guided biopsy. Cleve Clin Q. 1977. 44:27–33.

10. Kinoshita F, Kato T, Sugiura K, Nishimura M, Kinoshita T, Hashimoto M, et al. CT-guided transthoracic needle biopsy using a puncture site-down positioning technique. AJR Am J Roentgenol. 2006. 187:926–932.

11. Ohno Y, Hatabu H, Takenaka D, Imai M, Ohbayashi C, Sugimura K. Transthoracic CT-guided biopsy with multiplanar reconstruction image improves diagnostic accuracy of solitary pulmonary nodules. Eur J Radiol. 2004. 51:160–168.

12. Carlson SK, Felmlee JP, Bender CE, Ehman RL, Classic KL, Hoskin TL, et al. CT fluoroscopy-guided biopsy of the lung or upper abdomen with a breath-hold monitoring and feedback system: a prospective randomized controlled clinical trial. Radiology. 2005. 237:701–708.

13. Heck SL, Blom P, Berstad A. Accuracy and complications in computed tomography fluoroscopy-guided needle biopsies of lung masses. Eur Radiol. 2006. 16:1387–1392.

14. Irie T, Kajitani M, Matsueda K, Arai Y, Inaba Y, Kujiraoka Y, et al. Biopsy of lung nodules with use of I-I device under intermittent CT fluoroscopic guidance: preliminary clinical study. J Vasc Interv Radiol. 2001. 12:215–219.

15. Carlson SK, Bender CE, Classic KL, Zink FE, Quam JP, Ward EM, et al. Benefits and safety of CT fluoroscopy in interventional radiologic procedures. Radiology. 2001. 219:515–520.

16. Froelich JJ, Ishaque N, Regn J, Saar B, Walthers EM, Klose KJ. Guidance of percutaneous pulmonary biopsies with real-time CT fluoroscopy. Eur J Radiol. 2002. 42:74–79.

17. Gianfelice D, Lepanto L, Perreault P, Chartrand-Lefebvre C, Milette PC. Value of CT fluoroscopy for percutaneous biopsy procedures. J Vasc Interv Radiol. 2000. 11:879–884.

18. Yamagami T, Iida S, Kato T, Tanaka O, Toda S, Kato D, et al. Usefulness of new automated cutting needle for tissue-core biopsy of lung nodules under CT fluoroscopic guidance. Chest. 2003. 124:147–154.

19. Tsukada H, Satou T, Iwashima A, Souma T. Diagnostic accuracy of CT-guided automated needle biopsy of lung nodules. AJR Am J Roentgenol. 2000. 175:239–243.

20. Bladt O, De Wever W. Additional value of CT-fluoroscopic biopsy of pulmonary lesions: a retrospective study of 69 patients. JBR-BTR. 2006. 89:298–302.

21. Li H, Boiselle PM, Shepard JO, Trotman-Dickenson B, McLoud TC. Diagnostic accuracy and safety of CT-guided percutaneous needle aspiration biopsy of the lung: comparison of small and large pulmonary nodules. AJR Am J Roentgenol. 1996. 167:105–109.

22. Khouri NF, Stitik FP, Erozan YS, Gupta PK, Kim WS, Scott WW Jr, et al. Transthoracic needle aspiration biopsy of benign and malignant lung lesions. AJR Am J Roentgenol. 1985. 144:281–288.

23. Sagel SS, Ferguson TB, Forrest JV, Roper CL, Weldon CS, Clark RE. Percutaneous transthoracic aspiration needle biopsy. Ann Thorac Surg. 1978. 26:399–405.

24. Kurban LA, Gomersall L, Weir J, Wade P. Fluoroscopy-guided percutaneous lung biopsy: a valuable alternative to computed tomography. Acta Radiol. 2008. 49:876–882.

25. Teeuwisse WM, Geleijns J, Broerse JJ, Obermann WR, van Persijn van Meerten EL. Patient and staff dose during CT guided biopsy, drainage and coagulation. Br J Radiol. 2001. 74:720–726.

26. Manhire A, Charig M, Clelland C, Gleeson F, Miller R, Moss H, et al. Guidelines for radiologically guided lung biopsy. Thorax. 2003. 58:920–936.

27. Khan MF, Straub R, Moghaddam SR, Maataoui A, Gurung J, Wagner TO, et al. Variables affecting the risk of pneumothorax and intrapulmonal hemorrhage in CT-guided transthoracic biopsy. Eur Radiol. 2008. 18:1356–1363.