Percutaneous Transthoracic Lung Biopsy: Comparison Between C-Arm Cone-Beam CT and Conventional CT Guidance

Yun-Chung Cheng; Sheng-Heng Tsai; Yuchi Cheng; Jeon-Hor Chen; Jyh-Wen Chai; Clayton Chi-Chang Chen

doi:10.1016/j.tranon.2015.04.006

Percutaneous Transthoracic Lung Biopsy: Comparison Between C-Arm Cone-Beam CT and Conventional CT Guidance

Transl Oncol. 2015 Aug;8(4):258-64. doi: 10.1016/j.tranon.2015.04.006.

Authors

Yun-Chung Cheng¹, Sheng-Heng Tsai², Yuchi Cheng¹, Jeon-Hor Chen³, Jyh-Wen Chai¹, Clayton Chi-Chang Chen¹

Affiliations

¹ Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan, ROC.
² Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan, ROC. Electronic address: shengheng52@gmail.com.
³ Department of Radiology, Eda Hospital, Kaohsiung, Taiwan, ROC; I-Shou University, Kaohsiung City, Taiwan, ROC.

Abstract

Background: C-arm cone-beam computed tomography (CBCT) is a comparatively novel modality for guiding percutaneous transthoracic lung biopsies (PTLBs), and despite its potential advantages over conventional computed tomography (CCT), a head-to-head comparison of the two techniques has yet to be reported in the literature. This study aims to evaluate the diagnostic value and safety of CBCT-guided PTLB compared to CCT-guided biopsy, with cases performed in a single hospital.

Methods: A total of 104 PTLB patients were retrospectively analyzed in this study. 35 PTLBs were performed under CBCT guidance, and 69 PTLBs were performed under CCT guidance. Diagnostic accuracy, sensitivity, and specificity for malignancy as well as procedure time, radiation dose of patients, and complication rate in the two groups were compared.

Results: Total procedure time was significantly lower in the CBCT group (32 ± 11 minutes) compared to the CCT group (38 ± 9.7 minutes; P = .009), especially among patients ≥70 years of age (CBCT: 33 ± 12 minutes, CCT: 42 ± 13, P = .022). For lesions in the lower lobes, the CBCT-guided group received significantly reduced effective radiation dose (2.9 ± 1.6 mSv) than CCT-guided patients (3.7 ± 0.80; P = .042). Diagnostic accuracy, sensitivity, and specificity for malignancy were comparable between the two groups, as were post-biopsy complication rates.

Conclusion: CBCT guidance significantly reduces the procedure time and radiation exposure for PTLBs compared with CCT, and should be considered in clinical settings that may be difficult or time-consuming to perform under CCT.