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

Abstract

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.

Keywords: Biopsy, Needle; Lasers; Lung Neoplasms; Solitary Pulmonary Nodule.

Figure 1. Laser level (HG-909A; X-CLOVE) and a wheel bracket. (A) Laser level, adhered to a wheel bracket. (B, D) Overhead and side view of laser level. (C) Wheel part of a bracket.

Figure 2. (A) The laser level, adhered to a wheel bracket, mounted on a stainless steel frame and positioned on the opposite side of the computed tomography (CT) gantry. Horizontal movement is possible (blue arrows). (B) Both vertical laser beam lines, which came from the laser level and CT gantry, had been aligned, such that they looked like a line (red arrows). (C) The second laser level was placed on the side of the patient opposite to the operator, perpendicular to the other laser. (D) In the case of an oblique approach, a digital level (DWL-80E, Sincon) was used to tilt the laser level. The digital level was 29.9° (red round arrows).

Figure 3. Adjustment of the laser lines. (A, B) The laser line originating from the head end was located at the entry point on the skin and ran along the coaxial needle. (C, D) The intersection of the two laser lines originating from the head end and the side opposite to the operator were matched at the entry point on the skin and ran long the coaxial needle.

Figure 4. A 76-year-old woman who was diagnosed with non-small cell lung cancer (adenocarcinoma) by percutaneous transthoracic needle biopsy. (A) Axial view. (B) Sagittal view.