Computed tomography fluoroscopy-guided percutaneous biopsy of pulmonary nodules ≤ 10 mm: retrospective analysis of procedures performed during the COVID-19 pandemic

Abstract

Objective: To evaluate the diagnostic performance of computed tomography (CT) fluoroscopy-guided percutaneous transthoracic needle biopsy (PTNB) in pulmonary nodules ≤ 10 mm during the coronavirus disease 2019 pandemic.

Materials and methods: Between January 1, 2020 and April 30, 2022, a total of 359 CT fluoroscopy-guided PTNBs were performed at an interventional radiology center. Lung lesions measured between 2 mm and 108 mm. Of the 359 PTNBs, 27 (7.5%) were performed with an 18G core needle on nodules ≤ 10 mm in diameter.

Results: Among the 27 biopsies performed on nodules ≤ 10 mm, the lesions measured < 5 mm in four and 5-10 mm in 23. The sensitivity and overall diagnostic accuracy of PTNB were 100% and 92.3%, respectively. The mean dose of ionizing radiation during PTNB was 581.33 mGy*cm (range, 303-1,129 mGy*cm), and the mean biopsy procedure time was 6.6 min (range, 2-12 min). There were no major postprocedural complications.

Conclusion: CT fluoroscopy-guided PTNB appears to provide a high diagnostic yield with low complication rates.

Keywords: Fluoroscopy; Lung; Percutaneous biopsy; Pulmonary nodule; Tomography; X-ray computed.

Figure 1

Example of personal protective equipment for radiation protection, demonstrating the preparation of the physician-operator (interventional radiologist) for CT fluoroscopy-guided biopsy procedures: lead cap, eyewear, thyroid protection, lead apron, and gloves.

Figure 2

A 45-year-old woman with a history of breast cancer and emergence of a pulmonary nodule in the subpleural region of the left lower lobe, measuring 2 mm, in the left lateral position (ipsilateral to the lesion). The nodule was located at a depth of 5 mm, the needle was positioned at an angle of 45° in relation to the pleura, and two fragments of the nodule were removed. The total procedure time was 7 min, and the estimated radiation dose was 554 mGy*cm.

Figure 3

Lung biopsy fragment obtained from the patient depicted in Figure 2, showing carcinoma with a tubuloacinar pattern (hematoxylin-eosin staining; magnification, ×20). Immunohistochemistry revealed expression of GATA3 and CK7, corroborating the origin of the neoplasm in the breast.

Figure 4

A 67-year-old male patient with a spiculated nodule in the upper segment of the right lower lung lobe. A: CT scan acquired on the day of the percutaneous biopsy, showing a lesion measuring 10 mm. B: CT scan acquired three months after the procedure, showing a significant reduction in the size of the nodule (to 5 mm), confirming the histopathological findings, and corresponding to the clinical course.

Figure 5

Biopsy fragment obtained from the patient depicted in Figure 4, showing fragments of lung parenchyma with septal fibrosis and discrete nonspecific chronic inflammatory infiltrate, with lymphoid aggregates, and anthracnose foci.