Search

To retrospectively evaluate the diagnostic performance and complications of C-arm cone-beam computed tomography (CT)-guided percutaneous transthoracic needle biopsy (PTNB) in 1108 patients.This retrospective study was approved by the institutional review board with waiver of patient informed consent. From January 2009 to December 2011, 1108 patients (633 male, 475 female; mean age, 62.4 years ± 12.3 [standard deviation]) with 1116 pulmonary lesions (mean size, 2.7 cm ± 1.7) underwent 1153 cone-beam CT-guided PTNBs. A coaxial system with 18-gauge cutting needles was used. Diagnostic performance, complication rate, influencing factors, and patient radiation exposure were investigated. Variables influencing diagnostic performance and complications were assessed by using uni- and multivariate logistic regression analyses.Among 1153 PTNBs, pathologic analysis showed 1148 (99.6%) were technically successful (766 malignant [66.4%], 323 benign [28.0%], and 59 [5.1%] indeterminate). Sensitivity, specificity, and accuracy for diagnosis of malignancy were 95.7% (733 of 766), 100% (323 of 323), and 97.0% (1056 of 1089), respectively. In regard to diagnostic failures (five technical failures, 33 false-negative findings), lesions 1 cm in diameter or smaller and lesions in the lower lobe were significant risk factors (P = .028 and P = .034, respectively). As for complications, pneumothorax and hemoptysis occurred in 196 (17.0%) and 80 (6.9%) procedures, respectively. Multivariate analysis revealed two or more pleural passages and emphysema along the needle pathway were the two most significant risk factors for pneumothorax, and ground-glass nodules were the most significant risk factor for hemoptysis (P.001 for all). Virtual guidance was a significant protective factor for both pneumothorax and hemoptysis (P.001 for both). Mean estimated effective radiation dose through cone-beam CT-guided PTNBs was 7.3 mSv ± 4.1.Cone-beam CT-guided PTNB is a highly accurate and safe technique with which to diagnose pulmonary lesions with reasonable radiation exposure.

To evaluate the diagnostic accuracy, complications, and usefulness of transthoracic needle biopsy of small pulmonary nodules.Between January 1993 and January 1995, 302 patients underwent transthoracic needle biopsy of pulmonary lesions. Sixty-four lesions (in 62 patients) represented small nodules, defined as lesions of 15 mm or less maximum diameter. A total of 75 biopsies were performed in the 64 lesions. Approximately 90% of the biopsies were performed with computed tomographic guidance.There were 21 benign lesions and 43 cancers (36 primary, seven metastatic). Transthoracic needle biopsy findings were positive for cancer in 40 cases. In all three false-negative lesions, only one biopsy was performed. There were 21 true-negative results and no false-positive results. Positive and negative predictive values were 100% and 88%, respectively. Pneumothorax occurred in 20 (27%) of 75 biopsies, but chest tube placement was necessary in only three cases (4%). Surgery or thoracoscopy was avoided in 31 patients: 17 of 20 patients with benign disease, seven patients with metastatic disease, and seven patients with inoperable lung cancer.Transthoracic needle biopsy of small pulmonary nodules can produce diagnostic yields comparable with published results of transthoracic needle biopsy of larger lesions.

To determine the utility of coaxial transthoracic needle biopsy (TNB) with use of a 20-gauge automated cutting biopsy needle in the diagnosis of thoracic lesions.A retrospective review was performed in 122 patients. Computed tomography was used to guide coaxial TNB, which was performed with aspirating (n = 87) and automated cutting (n = 99) needles. The sensitivities for malignant and benign lesions were determined, with a comparison of the relative yields from the two techniques.The overall diagnostic yield for coaxial TNB was 88%. For malignancy the sensitivity was 95%, whereas a specific benign diagnosis was obtained in 91%. Although no difference was found for fine-needle aspiration versus core biopsy of malignant lesions (92% vs 86%), a statistically significant difference was found for benign lesions (44% vs 100%, P.05). Pneumothorax occurred in 54%.Coaxial TNB performed with an automated cutting needle helps provide a diagnosis in the majority of patients with focal chest disease and is particularly useful in the diagnosis of benign lesions.

A phantom to assist in the teaching of fluoroscopically guided transthoracic needle biopsy of pulmonary lesions was designed. The phantom was constructed of an aluminum and rubber skeleton, wood hemidiaphragms and heart, and foam rubber lungs and was covered with foam rubber. Modeling clay was used to simulate lesions. The authors believe the phantom is of value in helping increase the confidence and proficiency of the radiologist during the first few biopsy procedures with an actual patient.

The authors performed percutaneous transthoracic needle biopsy (PTNB) in 13 patients with acquired immunodeficiency syndrome (AIDS) and previously undiagnosed focal pulmonary lesions. Findings with PTNB were diagnostic in 11 of 13 cases. Complications included minimal hemoptysis in one case and small pneumothoraxes in two cases, one of which required chest tube drainage. The authors did not experience the high complication rate reported previously by some authors who used this diagnostic procedure in AIDS patients. In cases in which findings at fiberoptic bronchoscopy with transbronchial biopsy and lavage failed to provide a diagnosis, PTNB provided a reliable, relatively safe diagnostic tool to establish the cause of pulmonary masses or focal infiltrates in AIDS patients.

By Sven Dahlgren, M.D., Department of Pathology, and Bjorn Nordenstrom, M.D., Director, Department of Thoracic Radiology, Karolinska Institutet, Stockholm, Sweden. Cloth, $12.50. Pp. 132, with 70 figures. Chicago, Yr. Bk. Pub'rs., 1966. This very good monograph reports in detail on a large clinical experience with transthoracic needle biopsy. The material is well organized, clearly presented, reads easily, and will be a useful basic reference work for all those interested in initiating this technic. The authors have shown quite conclusively that needle biopsy of pulmonary lesions under roentgen television control has been sufficiently developed to become a clinically valuable diagnostic tool. It provides the opportunity for obtaining specific diagnostic information in those lesions that otherwise would not be obtainable except through open thoracotomy and excisional biopsy. Although needle biopsy of pulmonary lesions is not a new procedure, it was never generally accepted as a safe and accurate diagnostic...