Kwang Nam Jin MD, Presenter: Nothing to Disclose

Chang Min Park, Abstract Co-Author: Nothing to Disclose

Jin Mo Goo MD, PhD, Abstract Co-Author: Nothing to Disclose

Hyun Ju Lee MD, Abstract Co-Author: Nothing to Disclose

In Sun Lee MD, Abstract Co-Author: Nothing to Disclose

Youkyung Lee MD, Abstract Co-Author: Nothing to Disclose

Jung Im Kim MD, Abstract Co-Author: Nothing to Disclose

So Young Choi MD, Abstract Co-Author: Nothing to Disclose

00030490-DMT et al, Abstract Co-Author: Nothing to Disclose

State-of-the-art C-arm cone beam CT (CBCT) systems have technical strengths of allowing real-time fluoroscopy as well as CT imaging capabilities, and have great potential for clinical application in thoracic interventions. The purpose of this study was to describe the initial experience for percutaneous transthoracic biopsy (PCNB) of lung nodules using CBCT systems.

From January 2009 to March 2009, 45 consecutive patients with lung nodules ≤30mm (mean size, 20mm±0.6) who underwent CBCT (AXIOM Artis, Siemens; flat-panel detector, 2048x1538 elements)-guided PCNB using the coaxial cutting needle technique, were included in this study. The parameters of CBCT were as follows: 0.5o increment, 512x512 matrix, 211o total angle, 8-second rotation time and a total of 419 projections. We evaluated the technical success rate, diagnostic accuracy, incidence of complications, additional procedures due to complications, procedure time, number of needle repositionings, number of CT scans, and radiation dose.

The technical success rate, diagnostic accuracy, incidence of complications, and associated additional procedure rate were 100%, 95.6%, 43%, and 2.2%, respectively. Biopsy specimens were adequate for pathologic diagnosis in 100% of cases and a definitive pathologic diagnosis was made in 43 out of 45 patients: malignancy in 21 (46.7%), and benign in 22 (48.9%). In the remaining 2 patients (4.4%), the pathologic specimens and clinical course could not be definitive for a specific diagnosis. Complications included pneumothorax in 12 patients (26.7%) with one chest tube insertion (2.2%), hemoptysis in 5 (11.1%), and chest pain in one (2.2%). The mean procedure time, number of needle repositionings, number of CT scans and radiation dose were 19.1 minutes±5.9, 0.15 times±0.42, 2.9 times±0.73, and 269mGy ±113, respectively.  

Due to precise real-time visualization of the needle tip, accurate PCNB of lung nodules can be obtained without severe complications and few needle repositionings using CBCT systems.

With both real-time fluoroscopy and CT capabilities, CBCT systmes be used in thoracic interventions such as PCNB, tumor ablation and lesion localization with high confidence and accuracy.

Jin, K, Park, C, Goo, J, Lee, H, Lee, I, Lee, Y, Kim, J, Choi, S, et al, 0, C-arm Cone-Beam CT Systems: Initial Experience for Percutaneous Transthoracic Biopsy of Lung Nodules.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8013943.html