Initial Study Of Percutaneous Transthoracic Biopsy Of Small Pulmonary Nodules Using C-arm CT

Objective: To evaluate the preliminary clinical value of C-arm CT-guidedpercutaneous transthoracic biopsy of small(≤20mm) pulmonary nodules.Materials and Methods:40patients, a total of41small pulmonary nodules(diameter≤20mm) under C-arm CT-guided percutaneous transthoracic biopsies.The mean nodule size was15.4±1.6mm in diameter.25cases were male and15female,mean age57.9±13.2years old. Nodules were divided into two groups:(5～15) mmand (16～20) mm. To record the puncture depth of each nodule, operative timeand radiation doses. Technical success rate, diagnostic accuracy, sensitivity,specificity, positive predictive value, negative predictive value and incidenceof complications were also evaluated. Results: The biopsy results in41smallpulmonary nodules：27malignant lesions (65.9%%), benign lesions in13(31.7%%)，a pathological undetermined nodules (2.4%). The overall diagnostic accuracy was87.5%, sensitivity was81.5%，specificity was100%, positive predictive valuewas100%, negative predictive value was72.2%, five cases of false negative andno false positive. In the respect of diagnostic accuracy and sensitivity, thediameter (16～20) mm group were92%and89.5%, which was greater than80%and62.5%in the diameter (5～15) mm, however the results were no statisticallysignificant (P1=0.345、P2=0.136).3cases with clinical symptoms of complications,the incidence of complications were7.5%(including one cases of pneumothorax,two cases of hemoptysis merger pneumothorax, which were cured underwent pleuralfluid drainage), and the remaining patients were micro-needle tract bleeding andlittle pneumothorax without clinical treatment. The average effective dose was2.8±1.8mSv, and average cumulative dose was100.7±62mGy.Conclusion: The C-arm CT combine real-time fluoroscopy and CT features thatwill significantly overcome the lack of fluoroscopy and CT-guided percutaneous transthoracic biopsy, achieve real-time monitoring, precise positioning, rapidbiopsy to reduce the radiation damage, enhance intervention doctors operatingconfidence, improve biopsy accuracy, shorter operative time and reducecomplications. C-arm CT guide small pulmonary nodules(diameter≤20mm)percutaneous biopsy is safe, with high diagnostic accuracy, lighter complicationsand lower radiation dose, but should optimize the rotation CT function duringintra-operation to minimize radiation damage to the patient.