PURPOSE: To investigate the diagnostic accuracy of C-arm cone beam CT (CBCT)-guided percutaneous needle biopsy (PCNB) of small (≤20 mm) lung nodules and to evaluate the incidence of consequent pneumothorax and their influencing factors.
METHODS: One hundred thirty-five consecutive patients (67 men and 68 women; mean age, 59.4 years; range, 29-83 years) with 135 small (≤20 mm) pulmonary nodules underwent CBCT-guided PCNB using the coaxial core biopsy technique. Overall diagnostic accuracy, sensitivity, specificity, and pneumothorax rate were calculated and factors influencing the diagnostic accuracy and pneumothorax rate were statistically evaluated.
RESULTS: Sixty-six nodules (48.9%) were diagnosed as malignant, 59 (43.7%) as benign, and 10 (7.4%) as indeterminate. In PCNB, 122 nodules (15.2 ± 0.36mm) were correctly diagnosed and 3 nodules (13.7 ±0.32mm) were false negatives. Diagnostic accuracy, sensitivity, specificity, and incidence of pneumothorax were 98.4%, 95.5%, 100% and 28.1%, respectively. Nodule size, lesion depth from the pleura, and other factors did not influence the diagnostic accuracy of CBCT-guided PCNB. As for the pneumothorax rate, there were significant differences between the pneumothorax group and non-pneumothorax group regarding the presence of emphysema in the same lobe, emphysema in the needle path, pleural passage number, and presence of hemoptysis (p< 0.05). Multivariate analysis revealed that pleural passage number (adjusted odds ratio (OR), 3.31), and age (OR, 1.05) were significant risk factors, however the presence of hemoptysis (OR, 0.14) was significant protective factor for pneumothorax.
CONCLUSION: CBCT-guided PCNB is a very accurate diagnostic tool for lung nodules smaller than 20 mm in diameter and even for subcentimeter nodules. As for pneumothorax, pleural passage number and old age were the significant risk factors.
CLINICAL IMPLICATIONS: CBCT-guided PCNB is a very accurate diagnostic tool for small lung nodules and has enough potential to replace current image-guided PCNB using fluoroscopy or conventional CT.
DISCLOSURE: Chang Min Park, No Financial Disclosure Information; No Product/Research Disclosure Information