Abstract
The purpose of our study was to evaluate the feasibility and safety of CT-guided percutaneous lung biopsy using two needles in difficult and poorly cooperative patients; and to examine the usefulness of the malpositioned first needle in tissue sampling with a second needle. This study included 17 consecutive patients with unsuccessful first insertion of the biopsy needle in the normal lung parenchyma and re-attempted tissue sampling through another puncture site using a second needle with the first needle retained in position until completion of the biopsy. We examined the difficult factors in biopsy that led to a failed first attempt, success rate of tissue sampling, procedure-related complications, and usefulness of the malpositioned needle. There were 1 or multiple difficult factors in all patients. In all 17 patients, core samples were successfully obtained using a second needle. Post-procedure pneumothorax and parenchymal hemorrhage occurred in 4 and 3 patients, respectively. The first needle was used as a navigational reference point for lesion localization in all patients and as an anchor restricting the mobility of the lung in patients with pneumothorax or poor breath holding capacity. CT-guided needle biopsy of the lung using a second needle without removing the first malpositioned needle is feasible and safe. During biopsy procedures in difficult or poorly cooperative patients, the malpositioned needle provides a navigational reference point or serves as an anchor to hold the movable lung.
Highlights
Patients with a suspected malignant lung lesion require a diagnostic histopathology, and computed tomography (CT)-guided biopsy is a safe and widely used method for obtaining peripheral lung tissue (Connor et al 2000; Winokur et al 2013)
In these 17 patients, the first needle was inserted into the normal lung parenchyma, and the operator tried to target the lesion using a second needle while the first needle remained in position
In the era of multidetector computed tomography (MDCT), as more indeterminate lesions are detected in chest CTs, the thoracic radiologist often encounters patients with difficult lesions or who are poorly cooperative for percutaneous biopsies
Summary
Patients with a suspected malignant lung lesion require a diagnostic histopathology, and CT-guided biopsy is a safe and widely used method for obtaining peripheral lung tissue (Connor et al 2000; Winokur et al 2013). Radiologists carefully determine the position and needle trajectory based on the lesion location and characteristics on CT scan. In standard CTguided biopsy without using real-time monitoring tools such as CT fluoroscopy, the actual process of final lesion targeting is essentially performed blindly. The purpose of this study was to present our experience with CT-guided lung biopsy performed using two needles and to evaluate the feasibility and safety of the procedure. The role of the malpositioned needle, located in the normal lung parenchyma during the entire biopsy procedure, was reviewed.
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