CT-Guided Percutaneous Approach with Low-Dose Protocol for Performing Lung Biopsies

Abstract

Computed tomography-guided percutaneous needle biopsy of the lung is a safe and effective procedure for removal of rustling of lung cancer in patients requiring histological diagnosis and to be able to carry out molecular biology studies, it does not require hospitalization and considerably limits the use of surgical biopsy. The purpose of our study is to assess the sensitivity and specificity of CT guided percutaneous procedure considering the best approach in order to obtain an acceptable number of withdrawals reducing patient exposure to ionizing radiation. Prior to the procedure we evaluate the best percutaneous approach studying the imaging features of the lung nodule. At the beginning of the procedure were performed a basic volumetric chest CT scan for the localization of the nodule to choose the point of access with bright laser pointer and successive CT scans of 3 cm thickness with a lowdose technique to follow the needle trajectory until the nodule of interest. Key point of this study is the use of 16-18 Gauge coaxial needle or introducer inch, to reach the target lesion; it allows multiple biopsies reducing the number of percutaneous accesses: in fact, reached the lesion, is possible to slide inside it the needle with semiautomatic shearing system of the Tru-Cut type and make multiple withdrawals. We performed 106 percutaneous CT-guided pulmonary needle biopsy on patients aged 41 to 89 years, 76 males and 30 females; in only 2 cases (1.88% of the patients) we not obtained an accurate withdrawal of bioptic specimens for histological characterization of target lesion, and in just 2 cases the development of pneumothorax required placement of percutaneous thoracic drainage. This approach has been shown to have sensitivity and specificity of 98,1% and 97,1% respectively, for a proper selection of specimens and a correct histological diagnosis. A standardized and repeatable protocol for performing CT-guided biopsies is of key importance in order to reduce patient’s exposure to ionizing radiation, to gain the highest possible number of appropriate withdrawals and to minimize procedural complications.