Flat detector C-arm CT-guided transthoracic needle biopsy of small (≤2.0 cm) pulmonary nodules: diagnostic accuracy and complication in 100 patients

This study aimed at assessing the usefulness of flat detector cone-beam CT virtual navigation-guided transthoracic needle biopsy of small (≤2.0 cm) pulmonary nodules in terms of diagnostic accuracy and complications to evaluate the diagnostic performance and complications of small pulmonary nodules under cone-beam CT (CBCT) guidance. A total of 100 patients with 100 solid lung nodules were retrospectively enrolled to undergo transthoracic needle biopsy (TNB) procedures. The mean diameter of lesions was 1.25 cm ± 0.39 (range 0.50–2.00 cm). The needle path was carefully planned and calculated on the CBCT virtual navigation guidance system, which acquired 3D CT-like cross-sectional images. Diagnostic performance, complication rate, and patient radiation exposure were investigated. The technical success rate of TNB under iGuide CBCT virtual navigation system was 99 % (99/100). The sensitivity, specificity, and accuracy of TNB of small nodules under iGuide CBCT virtual navigation guidance were 98.7 % (77/78), 90.5 % (19/21), and 97.0 % (96/99), respectively. The number of pleural passages with coaxial needle, biopsies, and CBCT acquisitions were 1.09 ± 0.32, 1.20 ± 0.47, and 3.06 ± 1.35, respectively. Complications occurred in 22 (22 %) cases. The mean total procedure time was 12.84 min ± 3.74, resulting in a mean exposure dose of 7.6 mSv ±3.1. Flat detector Cone-beam CT-guided TNB is a highly accurate and safe diagnostic method for small (≤2.0 cm) lung nodule.