Tuberculosis and Respiratory Diseases

  • 제81권4호
  • /
  • Pages.330-338
  • /
  • 2018
  • /
  • 1738-3536(pISSN)
  • /
  • 2005-6184(eISSN)
대한결핵및호흡기학회 (The Korean Academy of Tuberculosis and Respiratory Diseases)
권호 표지
DOI QR코드

DOI QR Code

CT-Guided Percutaneous Transthoracic Needle Biopsy Using the Additional Laser Guidance System by a Pulmonologist with 2 Years of Experience in CT-Guided Percutaneous Transthoracic Needle Biopsy

  • Jeon, Min-Cheol (Department of Radiology, Daejeon Health Institute of Technology) ;
  • Kim, Ju Ock (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital) ;
  • Jung, Sung Soo (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital) ;
  • Park, Hee Sun (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital) ;
  • Lee, Jeong Eun (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital) ;
  • Moon, Jae Young (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital) ;
  • Chung, Chae Uk (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital) ;
  • Kang, Da Hyun (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital) ;
  • Park, Dong Il (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital)
  • 투고 : 2017.12.03
  • 심사 : 2018.02.20
  • 발행 : 2018.10.31
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Background: We developed an additional laser guidance system to improve the efficacy and safety of conventional computed tomography (CT)-guided percutaneous transthoracic needle biopsy (PTNB), and we conducted this study to evaluate the efficacy and safety of our system. Methods: We retrospectively analyzed the medical records of 244 patients who underwent CT-guided PTNB using our additional laser guidance system from July 1, 2015, to January 20, 2016. Results: There were nine false-negative results among the 238 total cases. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of our system for diagnosing malignancy were 94.4% (152/161), 100% (77/77), 100% (152/152), 89.5% (77/86), and 96.2% (229/238), respectively. The results of univariate analysis showed that the risk factors for a false-negative result were male sex (p=0.029), a final diagnosis of malignancy (p=0.033), a lesion in the lower lobe (p=0.035), shorter distance from the skin to the target lesion (p=0.003), and shorter distance from the pleura to the target lesion (p=0.006). The overall complication rate was 30.5% (74/243). Pneumothorax, hemoptysis, and hemothorax occurred in 21.8% (53/243), 9.1% (22/243), and 1.6% (4/243) of cases, respectively. Conclusion: The additional laser guidance system might be a highly economical and efficient method to improve the diagnostic efficacy and safety of conventional CT-guided PTNB even if performed by inexperienced pulmonologists.

키워드

참고문헌

  1. DiBardino DM, Yarmus LB, Semaan RW. Transthoracic needle biopsy of the lung. J Thorac Dis 2015;7(Suppl 4):S304-16.
  2. Jin KN, Park CM, Goo JM, Lee HJ, Lee Y, Kim JI, et al. Initial experience of percutaneous transthoracic needle biopsy of lung nodules using C-arm cone-beam CT systems. Eur Radiol 2010;20:2108-15. https://doi.org/10.1007/s00330-010-1783-x
  3. Lee SM, Park CM, Lee KH, Bahn YE, Kim JI, Goo JM. C-arm cone-beam CT-guided percutaneous transthoracic needle biopsy of lung nodules: clinical experience in 1108 patients. Radiology 2014;271:291-300. https://doi.org/10.1148/radiol.13131265
  4. Yan GW, Bhetuwal A, Yan GW, Sun QQ, Niu XK, Zhou Y, et al. A systematic review and meta-analysis of C-arm cone-beam CT-guided percutaneous transthoracic needle biopsy of lung nodules. Pol J Radiol 2017;82:152-60. https://doi.org/10.12659/PJR.899626
  5. Zhuang YP, Wang HY, Zhang J, Feng Y, Zhang L. Diagnostic accuracy and safety of CT-guided fine needle aspiration biopsy in cavitary pulmonary lesions. Eur J Radiol 2013;82:182-6. https://doi.org/10.1016/j.ejrad.2012.09.011
  6. Li Y, Du Y, Yang HF, Yu JH, Xu XX. CT-guided percutaneous core needle biopsy for small ($\leq$20 mm) pulmonary lesions. Clin Radiol 2013;68:e43-8. https://doi.org/10.1016/j.crad.2012.09.008
  7. Loh SE, Wu DD, Venkatesh SK, Ong CK, Liu E, Seto KY, et al. CT-guided thoracic biopsy: evaluating diagnostic yield and complications. Ann Acad Med Singapore 2013;42:285-90.
  8. Takeshita J, Masago K, Kato R, Hata A, Kaji R, Fujita S, et al. CT-guided fine-needle aspiration and core needle biopsies of pulmonary lesions: a single-center experience with 750 biopsies in Japan. AJR Am J Roentgenol 2015;204:29-34. https://doi.org/10.2214/AJR.14.13151
  9. Yang W, Sun W, Li Q, Yao Y, Lv T, Zeng J, et al. Diagnostic accuracy of CT-guided transthoracic needle biopsy for solitary pulmonary nodules. PLoS One 2015;10:e0131373. https://doi.org/10.1371/journal.pone.0131373
  10. Yaffe D, Koslow M, Haskiya H, Shitrit D. A novel technique for CT-guided transthoracic biopsy of lung lesions: improved biopsy accuracy and safety. Eur Radiol 2015;25:3354-60. https://doi.org/10.1007/s00330-015-3750-z
  11. Choi SH, Chae EJ, Kim JE, Kim EY, Oh SY, Hwang HJ, et al. Percutaneous CT-guided aspiration and core biopsy of pulmonary nodules smaller than 1 cm: analysis of outcomes of 305 procedures from a tertiary referral center. AJR Am J Roentgenol 2013;201:964-70. https://doi.org/10.2214/AJR.12.10156
  12. Choo JY, Park CM, Lee NK, Lee SM, Lee HJ, Goo JM. Percutaneous transthoracic needle biopsy of small (${\leq}$ 1 cm) lung nodules under C-arm cone-beam CT virtual navigation guidance. Eur Radiol 2013;23:712-9. https://doi.org/10.1007/s00330-012-2644-6
  13. Hwang HS, Chung MJ, Lee JW, Shin SW, Lee KS. C-arm conebeam CT-guided percutaneous transthoracic lung biopsy: usefulness in evaluation of small pulmonary nodules. AJR Am J Roentgenol 2010;195:W400-7. https://doi.org/10.2214/AJR.09.3963
  14. Larke FJ, Kruger RL, Cagnon CH, Flynn MJ, McNitt-Gray MM, Wu X, et al. Estimated radiation dose associated with lowdose chest CT of average-size participants in the National Lung Screening Trial. AJR Am J Roentgenol 2011;197:1165-9. https://doi.org/10.2214/AJR.11.6533
  15. Hiraki T, Mimura H, Gobara H, Iguchi T, Fujiwara H, Sakurai J, et al. CT fluoroscopy-guided biopsy of 1,000 pulmonary lesions performed with 20-gauge coaxial cutting needles: diagnostic yield and risk factors for diagnostic failure. Chest 2009;136:1612-7. https://doi.org/10.1378/chest.09-0370
  16. Chami HA, Faraj W, Yehia ZA, Badour SA, Sawan P, Rebeiz K, et al. Predictors of pneumothorax after CT-guided transthoracic needle lung biopsy: the role of quantitative CT. Clin Radiol 2015;70:1382-7. https://doi.org/10.1016/j.crad.2015.08.003
  17. Boskovic T, Stanic J, Pena-Karan S, Zarogoulidis P, Drevelegas K, Katsikogiannis N, et al. Pneumothorax after transthoracic needle biopsy of lung lesions under CT guidance. J Thorac Dis 2014;6 Suppl 1:S99-107.
  18. van Haren-Willems J, Heijdra Y. Increasing evidence for gender differences in chronic obstructive pulmonary disease. Womens Health (Lond) 2010;6:595-600. https://doi.org/10.2217/WHE.10.37
  19. Yeow KM, Tsay PK, Cheung YC, Lui KW, Pan KT, Chou AS. Factors affecting diagnostic accuracy of CT-guided coaxial cutting needle lung biopsy: retrospective analysis of 631 procedures. J Vasc Interv Radiol 2003;14:581-8. https://doi.org/10.1097/01.RVI.0000071087.76348.C7
  20. Ko JP, Shepard JO, Drucker EA, Aquino SL, Sharma A, Sabloff B, et al. Factors influencing pneumothorax rate at lung biopsy: are dwell time and angle of pleural puncture contributing factors? Radiology 2001;218:491-6. https://doi.org/10.1148/radiology.218.2.r01fe33491
  21. Khan MF, Straub R, Moghaddam SR, Maataoui A, Gurung J, Wagner TO, et al. Variables affecting the risk of pneumothorax and intrapulmonal hemorrhage in CT-guided transthoracic biopsy. Eur Radiol 2008;18:1356-63. https://doi.org/10.1007/s00330-008-0893-1
  22. Rotolo N, Floridi C, Imperatori A, Fontana F, Ierardi AM, Mangini M, et al. Comparison of cone-beam CT-guided and CT fluoroscopy-guided transthoracic needle biopsy of lung nodules. Eur Radiol 2016;26:381-9. https://doi.org/10.1007/s00330-015-3861-6
  23. Adiga S, Athreya S. Safety, efficacy, and feasibility of an ultralow dose radiation protocol for CT-guided percutaneous needle biopsy of pulmonary lesions: initial experience. Clin Radiol 2014;69:709-14. https://doi.org/10.1016/j.crad.2014.02.006
  24. Lechuga L, Weidlich GA. Cone beam CT vs. fan beam CT: a comparison of image quality and dose delivered between two differing CT imaging modalities. Cureus 2016;8:e778.
  25. Schegerer AA, Lechel U, Ritter M, Weisser G, Fink C, Brix G. Dose and image quality of cone-beam computed tomography as compared with conventional multislice computed tomography in abdominal imaging. Invest Radiol 2014;49:675-84. https://doi.org/10.1097/RLI.0000000000000069
  26. Ravenel JG, Scalzetti EM, Huda W, Garrisi W. Radiation exposure and image quality in chest CT examinations. AJR Am J Roentgenol 2001;177:279-84. https://doi.org/10.2214/ajr.177.2.1770279
  27. Hirota S, Nakao N, Yamamoto S, Kobayashi K, Maeda H, Ishikura R, et al. Cone-beam CT with flat-panel-detector digital angiography system: early experience in abdominal interventional procedures. Cardiovasc Intervent Radiol 2006;29:1034-8. https://doi.org/10.1007/s00270-005-0287-6

피인용 문헌

  1. Initial Experience in CT-Guided Percutaneous Transthoracic Needle Biopsy of Lung Lesions Performed by a Pulmonologist vol.8, pp.6, 2018, https://doi.org/10.3390/jcm8060821
  2. Biomarkers and diagnostic tools for lung cancer vol.64, pp.1, 2018, https://doi.org/10.5124/jkma.2021.64.1.66
  3. Real-World Diagnostic Accuracy and Use of Immunohistochemical Markers in Lung Cancer Diagnostics vol.11, pp.11, 2021, https://doi.org/10.3390/biom11111721