Computed tomography-guided core needle biopsy for lung nodules: low-dose versus standard-dose protocols

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Abstract

Introduction

Computed tomography (CT)-guided core needle biopsy (CNB) is an essential step in the management of lung nodules (LNs). Low-dose CT (LDCT)-guided CNB has been used to decrease the radiation exposure.

Aim

To evaluate the technical success, safety, diagnostic capacity, and radiation exposure to patients between LDCT-guided and standard-dose CT (SDCT)-guided CNB for LNs.

Material and methods

This is a retrospective, single-centre study. Patients who underwent LDCT-guided or SDCT-guided CNB for LNs from January 2015 to December 2017 were included. Data on technical success, diagnostic performance, complications, and radiation exposure were collected and analysed.

Results

A total of 70 and 65 patients underwent LDCT-guided and SDCT-guided CNB procedure, respectively. The technical success rates were 100% in both groups. The diagnostic yield, sensitivity, specificity, and overall diagnostic accuracy in the LDCT and SDCT groups were 71.4% and 67.7% (p = 0.637), 97.8% and 93.2% (p = 0.625), 100%, and 100%, and 98.6% and 95.4% (p = 0.560), respectively. The independent risk factor of diagnostic failure was less sample tissues (p = 0.012; 95% confidence interval: 0.033–0.651). Pneumothorax was found in 9 and 12 patients in the LDCT and SDCT groups, respectively (p = 0.369). Lung haemorrhage was found in 11 and 12 patients in the LDCT and SDCT groups, respectively (p = 0.671). The mean dose-length product was 38.3 ±17.0 mGy · cm and 376.0 ±118.7 mGy · cm in the LDCT and SDCT groups, respectively (p < 0.001).

Conclusions

Compared to SDCT, LDCT-guided CNB can provide comparable safety and diagnostic performance for LNs while reducing exposure to radiation.

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Most cited references 16

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Complication rates of CT-guided transthoracic lung biopsy: meta-analysis

W. Heerink, G H de Bock, G. J. de Jonge … (2016)

Objectives To meta-analyze complication rate in computed tomography (CT)-guided transthoracic lung biopsy and associated risk factors. Methods Four databases were searched from 1/2000 to 8/2015 for studies reporting complications in CT-guided lung biopsy. Overall and major complication rates were pooled and compared between core biopsy and fine needle aspiration (FNA) using the random-effects model. Risk factors for complications in core biopsy and FNA were identified in meta-regression analysis. Results For core biopsy, 32 articles (8,133 procedures) were included and for FNA, 17 (4,620 procedures). Pooled overall complication rates for core biopsy and FNA were 38.8 % (95 % CI: 34.3–43.5 %) and 24.0 % (95 % CI: 18.2–30.8 %), respectively. Major complication rates were 5.7 % (95 % CI: 4.4–7.4 %) and 4.4 % (95 % CI: 2.7–7.0 %), respectively. Overall complication rate was higher for core biopsy compared to FNA (p < 0.001). For FNA, larger needle diameter was a risk factor for overall complications, and increased traversed lung parenchyma and smaller lesion size were risk factors for major complications. For core biopsy, no significant risk factors were identified. Conclusions In CT-guided lung biopsy, minor complications were common and occurred more often in core biopsy than FNA. Major complication rate was low. For FNA, smaller nodule diameter, larger needle diameter and increased traversed lung parenchyma were risk factors for complications. Key Points • Minor complications are common in CT-guided lung biopsy • Major complication rate is low in CT-guided lung biopsy • CT-guided lung biopsy complications occur more often in core biopsy than FNA • Major complication rate is similar in core biopsy and FNA • Risk factors for FNA are larger needle diameter, smaller lesion size Electronic supplementary material The online version of this article (doi:10.1007/s00330-016-4357-8) contains supplementary material, which is available to authorized users.

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Non-Small Cell Lung Cancer, Version 6.2015.

David Ettinger, Douglas E Wood, Wallace Akerley … (2015)

These NCCN Guidelines Insights focus on recent updates to the 2015 NCCN Guidelines for Non-Small Cell Lung Cancer (NSCLC). Appropriate targeted therapy is very effective in patients with advanced NSCLC who have specific genetic alterations. Therefore, it is important to test tumor tissue from patients with advanced NSCLC to determine whether they have genetic alterations that make them candidates for specific targeted therapies. These NCCN Guidelines Insights describe the different testing methods currently available for determining whether patients have genetic alterations in the 2 most commonly actionable genetic alterations, notably anaplastic lymphoma kinase (ALK) gene rearrangements and sensitizing epidermal growth factor receptor (EGFR) mutations.

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Percutaneous transthoracic needle biopsy of small (≤ 1 cm) lung nodules under C-arm cone-beam CT virtual navigation guidance.

Patricia Lee, Shin-Hyung Park, S Lee … (2013)

To describe our initial experience with percutaneous transthoracic needle biopsy (PCNB) of small (≤1 cm) lung nodules using a cone-beam computed tomography (CBCT) virtual navigation guidance system in 105 consecutive patients. One hundred and five consecutive patients (55 male, 50 female; mean age, 62 years) with 107 small (≤1 cm) lung nodules (mean size, 0.85 cm ± 0.14) underwent PCNBs under CBCT virtual-navigation guidance system and constituted our study population. Procedural details-including radiation dose, sensitivity, specificity, diagnostic accuracy and complication rates of CBCT virtual navigation guided PCNBs-were described. The mean number of pleural passages with the coaxial needle, biopsies, CT acquisitions, total procedure time, coaxial introducer dwelling time, and estimated radiation exposure during PCNBs were 1.03 ± 0.21, 3.1 ± 0.7, 3.4 ± 1.3, 10.5 min ± 3.2 and 7.2 min ± 2.5, and 5.72 mSv ± 4.19, respectively. Sixty nodules (56.1 %) were diagnosed as malignant, 38 (35.5 %) as benign and nine (8.4 %) as indeterminate. The sensitivity, specificity, and diagnostic accuracy of CBCT virtual-navigation-guided PCNB for small (≤1 cm) nodules were 96.7 % (58/60), 100 % (38/38) and 98.0 % (96/98), respectively. Complications occurred in 13 (12.1 %) cases; pneumothorax in seven (6.5 %) and haemoptysis in six (5.6 %). CBCT virtual-navigation-guided PCNB is a highly accurate and safe diagnostic method for small (≤1 cm) nodules.

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Author and article information

Journal

Journal ID (nlm-ta): Wideochir Inne Tech Maloinwazyjne

Journal ID (iso-abbrev): Wideochir Inne Tech Maloinwazyjne

Journal ID (publisher-id): WIITM

Title: Videosurgery and other Miniinvasive Techniques

Publisher: Termedia Publishing House

ISSN (Print): 1895-4588

ISSN (Electronic): 2299-0054

Publication date (Electronic): 03 February 2021

Publication date (Print): June 2021

Volume: 16

Issue: 2

Pages: 355-361

Affiliations

[1 ]Medical College, Yangzhou University, Yangzhou, China

[2 ]Department of Radiology, No. 6 Hospital of Shanghai Jiaotong University, Shanghai, China

Author notes

Address for correspondence Guang-Chao Li, Department of Radiology, No. 6 Hospital of Shanghai Jiaotong University, Shanghai, China. e-mail: ligch06@ 123456126.com

Article

Publisher ID: 43192

DOI: 10.5114/wiitm.2021.103303

PMC ID: 8193745

PubMed ID: 34136031

SO-VID: abf6205d-4d39-49a3-bd50-75cc6cebf915

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.

Computed tomography-guided core needle biopsy for lung nodules: low-dose versus standard-dose protocols

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Abstract

Introduction

Aim

Material and methods

Results

Conclusions

Related collections

JMIR: Research Protocols

Most cited references 16

Complication rates of CT-guided transthoracic lung biopsy: meta-analysis

Non-Small Cell Lung Cancer, Version 6.2015.

Percutaneous transthoracic needle biopsy of small (≤ 1 cm) lung nodules under C-arm cone-beam CT virtual navigation guidance.

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