Percutaneous transthoracic needle biopsy of small (aparts per thousandcurrency sign1 cm) lung nodules under C-arm cone-beam CT virtual navigation guidance

To describe our initial experience with percutaneous transthoracic needle biopsy (PCNB) of small (a parts per thousand currency sign1 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 (a parts per thousand currency sign1 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 (a parts per thousand currency sign1 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 (a parts per thousand currency sign1 cm) nodules.