C-arm cone-beam CT-guided percutaneous transthoracic needle biopsy of small (≤ 20 mm) lung nodules: Diagnostic accuracy and complications in 161 patients

OBJECTIVE. The purpose of this study is to retrospectively evaluate the diagnostic accuracy and complications of C-arm cone-beam CT (CBCT) - guided percutaneous transthoracic needle biopsy (PTNB) for small (≤ 20 mm) lung nodules and their possible influencing factors. Materi als and met hods. From March 2009 to July 2010, 161 consecutive patients (77 men and 84 women; mean [± SD] age, 61 ± 11.8 years; range, 29-85 years) with 173 small (≤ 20 mm) lung nodules underwent CBCT-guided PTNB performed by an experienced chest radiologist in a tertiary referral hospital. The diagnostic accuracy, sensitivity, specificity, and complication rates were statistically evaluated, and influencing factors were assessed using univariate and subsequent multivariate analysis. RESULTS. Of 173 nodules (mean size, 15 ± 3.7 mm), 94 (54.3%) were diagnosed as malignant, 69 (39.9%) as benign, and 10 (5.8%) as indeterminate. On PTNB, 160 nodules were correctly diagnosed and three were false-negatives. Diagnostic accuracy, sensitivity, and specificity were 98.2%, 96.8%, and 100%, respectively. No factors significantly decreased diagnostic accuracy. As for complications, pneumothorax, hemoptysis, and chest pain occurred in 55 (31.8%), 25 (14.5%), and two (1.2%) patients, respectively. Multivariate analysis revealed that the presence of emphysema along the needle pathway was a significant risk factor (odds ratio [OR], 10.11), and the occurrence of hemoptysis was a significant protective factor (OR, 0.28) against pneumothorax. Ground-glass nodules were found to be a significant independent risk factor for hemoptysis (OR, 5.10). CONCLUSION. C-arm CBCT-guided PTNB is highly accurate for small lung nodules, and the diagnostic accuracy does not significantly decrease even in technically challenging conditions.