Novel Laser System-Assisted CT-Guided Percutaneous Transthoracic Lung Biopsy in Patients with COPD Combined with Pulmonary Nodules

Abstract

Objective: The diagnosis and management of pulmonary nodules in patients with COPD are challenging, as these nodules may represent either lung cancer or other pulmonary diseases. This study aims to evaluate the efficiency of a novel laser systems (LGS)-assisted CT-guided percutaneous lung biopsy in COPD patients with pulmonary nodules.

Methods: A retrospective analysis was conducted on the data of 60 COPD patients with pulmonary nodules. Thirty patients (n=30) underwent CT-guided percutaneous transthoracic lung biopsy assisted by LGS, while the remaining 30 (n=30) underwent conventional manual CT-guided percutaneous transthoracic lung biopsy. The surgical time, number of punctures, CT scan frequency, and complications were compared between the two groups.

Results: No significant differences were found between the two groups in terms of clinical characteristics, lesion size, location, puncture depth, or nodule nature. Compared to the traditional method, LGS-assisted CT-guided percutaneous lung biopsy significantly reduced the number of CT scans (2.3 ± 0.5 vs 3.2 ± 0.6, P < 0.001) and the average procedure time (12.6 ± 2.7 min vs 25.1 ± 3.4 min, P < 0.001). Additionally, the total intraoperative time per procedure was significantly reduced (25.1 ± 3.4 min vs 45.9 ± 8.8 min, P < 0.001). With the use of LGS, 73% (22/30) of the procedures hit the target on the first needle insertion, compared to only 6.7% (2/30) in the conventional group. Furthermore, there was no significant difference in the incidence of complications between the two groups.

Conclusion: Compared to the traditional method, the use of LGS improved puncture efficiency in COPD patients, reduced the need for needle adjustments, and effectively shortened the procedure time.

Keywords: COPD; CT; PTNB; novel laser systems; pulmonary nodules.

Figure 1

Principle of the Laser-Guided System (LGS). (A) The red laser is positioned on the patient’s foot or head side to determine the puncture angle; the green laser is placed on the opposite side of the operator to determine the puncture plane. (B) The fan-shaped column represents the patient’s chest, and the irregular circular shape represents the pulmonary nodule. The red line represents the red laser, which defines the angle, while the green laser determines the puncture plane, guiding the puncture needle. (C) The puncture needle is advanced under the guidance of the two sets of lasers.

Figure 2

Operation Workflow of the Laser-Guided System (LGS) Assisted CT-PTNB. (A) Attach the custom-made grid to the patient’s chest. (B) Perform preoperative CT scan to plan the puncture path. (C) Adjust the CT slice to the puncture cross-section. (D) Adjust the angle of the red laser device to the specific value consistent with the planned angle. (E) Mark the puncture point on the body surface. (F) Attach the device to the appropriate position. (G) Ensure that the two laser beams intersect at the puncture point. (H) The operator inserts the coaxial needle under the real-time guidance of the two laser beams. (I) Perform another CT scan to observe if any complications occur. (J) Obtain lung tissue and promptly fix it in formalin.