Clinical Application Of C-arm Cone-beam CT Combining With IGuide Guidance System In Performing Percutaneous Transthoracic Needle Biopsy Of Pulmonary Masses

ObjectiveThe purpose of this study is to evaluate the diagnostic performance and complications of C-arm cone-beam CT(CBCT)combined with iGuide guidance system in performing percutaneous transthoracic needle biopsy(PTNB)of pulmonary masses and their possible influencing factors.Materials and MethodsA total of 30 patients(20 male,10 female;58.4 years ± 16.4 [mean ± standard deviation])with 30 lung masses were retrospectively enrolled to undergo PTNB procedures.The mean diameter of masses was 3.4 cm ± 1.9(range 0.8–8.2 cm).The needle path was carefully planned and calculated on the CBCT iGuide guidance system,which acquired 3D CT-like multiplanar reconstruction images.A coaxial system with 18-gauge cutting needle was used.Diagnostic performance,procedure details,complication rate,and patient radiation exposure were statistically evaluated,and possibly influencing factors were analyzed.ResultsOf 30 masses,pathologic analysis showed 24(80%)were diagnosed as malignant,6(20%)as benign.On PTNB,28 nodules were correctly diagnosed and 2 were failed(1 technical failures,1 false-negative findings).Diagnostic accuracy,sensitivity,specificity,PPV and NPV were 93%,96%,100%,100%,83%,respectively.There were significant differences between correct diagnosis group and wrong diagnosis group interms of nodule internal feature(p = 0.023).As for complications,pneumothorax and hemoptysis occurred in 6(20%)and 3(10%)patients.There were significant differences between the pneumothorax group and the nonpneumothorax groups in terms of the presence of emphysema or bullae along the needle pathway(p = 0.001)and No.of biopsies(p = 0.003).With respect to hemoptysis,there were significant differences between patients with and without hemoptysis in terms of age(p = 0.009),biopsy depth(p = 0.041),nodule internal feature(p = 0.009),and the No.of biopsies(p = 0.022).The mean total procedure time was 13.0 min ± 3.6,resulting in a mean exposure dose of 7.9 mSv ± 4.6.ConclusionThe use of CBCT combined with iGuide guidance system for PTNB is a highly accurate and safe technique with which to diagnose pulmonary masses with reasonable radiation exposure.