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J Korean Soc Radiol. 2015 Oct;73(4):216-224. Korean. Original Article. https://doi.org/10.3348/jksr.2015.73.4.216
Lee KJ , Han YM , Jin GY , Song JS .
Department of Radiology, Chonbuk National University Hospital and Medical School, Jeonju, Korea. ymhan@jbnu.ac.kr
Research Institute of Clinical Medicine, Chonbuk National University Hospital and Medical School, Jeonju, Korea.
Institute of Cardiovascular Research, Chonbuk National University Hospital and Medical School, Jeonju, Korea.
Abstract

PURPOSE: To evaluate the predicting factors for conversion from fluoroscopy guided percutaneous transthoracic needle biopsy (PTNB) to cone-beam CT guided PTNB. MATERIALS AND METHODS: From January 2011 to December 2012, we retrospectively identified 38 patients who underwent cone-beam CT guided PTNB with solid pulmonary lesions, and 76 patients who underwent fluoroscopy guided PTNB were matched to the patients who underwent cone-beam CT guided PTNB for age, sex, and lesion location. We evaluated predicting factors such as, long-axis diameter, short-axis diameter, anterior-posterior diameter, and CT attenuation value of the solid pulmonary lesion affecting conversion from fluoroscopy guided PTNB to cone-beam CT guided PTNB. Pearson chi2 test, Fisher exact test, and independent t test were used in statistical analyses; in addition, we also used receiver operating characteristics curve to find the proper cut-off values affecting the conversion to cone-beam CT guided PTNB. RESULTS: Short-axis, long-axis, anterior-posterior diameter and CT attenuation value of the solid pulmonary lesion in patients who underwent fluoroscopy guided PTNB were 2.70 +/- 1.57 cm, 3.40 +/- 1.92 cm, 3.06 +/- 1.81 cm, and 35.67 +/- 15.70 Hounsfield unit (HU), respectively. Short-axis, long-axis, anterior-posterior diameter and CT attenuation value of the solid pulmonary lesion in patients who underwent cone-beam CT guided PTNB were 1.60 +/- 1.30 cm, 2.20 +/- 1.45 cm, 1.91 +/- 1.99 cm, and 18.32 +/- 23.11 HU, respectively. Short-axis, long-axis, anterior-posterior diameter, and CT attenuation value showed a significantly different mean value between the 2 groups (p = 0.001, p < 0.001, p = 0.003, p < 0.001, respectively). Odd ratios of CT attenuation value and short-axis diameter of the solid pulmonary lesion were 0.952 and 0.618, respectively. Proper cut-off values affecting the conversion to cone-beam CT guided PTNB were 1.65 cm (sensitivity 68.4%, specificity 71.1%) in short-axis diameter and 29.50 HU (sensitivity 65.8%, specificity 65.8%) in CT attenuation value. CONCLUSION: Low CT attenuation value and small short-axis diameter of the solid pulmonary lesion affect conversion from fluoroscopy guided PTNB to cone-beam CT guided PTNB.

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