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CT fluoroscopy improves lung biopsy accuracy
By Reuters Health
December 16, 2009

NEW YORK (Reuters Health), Dec 16 - Lung biopsies guided by CT fluoroscopy have a higher diagnostic yield than biopsies guides by conventional CT, Japanese researchers report in the December issue of Chest.

The results show "high diagnostic accuracy even for small lesions; this is presumably thanks to the use of CT fluoroscopy," lead author Dr. Takao Hiraki told Reuters Health.

Dr. Hiraki and colleagues at Okayama University Medical School retrospectively evaluated 1,000 lung biopsies performed with 20-gauge coaxial cutting needles in 901 patients.

The results were non-diagnostic in 0.6%. The authors point out that this rate compares favorably with the 3.3% non-diagnosis rate seen in a study of 846 biopsies performed with conventional CT guidance and 20-gauge or 21-gauge aspiration needles or core needles.

In the current study, the sensitivity of CT fluoroscopy-guided biopsy for diagnosis of malignancy was 94.2% and the specificity was 99.1%. The overall diagnostic accuracy was 95.2%, and for lesions of 1.0 cm or less it was 92.7%.

Factors independently associated with diagnostic failure were having two or less specimens (odds ratio, 2.43); lesions in the lower lobe (OR, 2.50); malignant lesions (OR, 7.16); and lesions smaller than 1.0 cm (OR, 3.85) or larger than 3.1 cm (OR, 4.32).

The team also notes that "the use of the coaxial needle system contributes to a high diagnostic yield because this system may facilitate the acquisition of multiple specimens."

"In this study," they add, "three or more specimens were collected for 52% of the lesions."

By David Douglas

Chest 2009;136:1612-1617.

Last Updated: 2009-12-15 20:39:10 -0400 (Reuters Health)

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a youtube video showing percutaneous pulmonary biopsy with real-time CT fluoroscopy: although likely not from these researchers:

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CHEST December 2009 vol. 136 no. 6 1612-1617.

CT Fluoroscopy-Guided Biopsy of 1,000 Pulmonary Lesions Performed With 20-Gauge Coaxial Cutting Needles
Diagnostic Yield and Risk Factors for Diagnostic Failure
Takao Hiraki, MD, Hidefumi Mimura, MD, Hideo Gobara, MD, Toshihiro Iguchi, MD, Hiroyasu Fujiwara, MD, Jun Sakurai, MD, Yusuke Matsui, MD, Daisaku Inoue, MD, Shinichi Toyooka, MD, Yoshifumi Sano, MD and Susumu Kanazawa, MD
+ Author Affiliations

Affiliations: From the Departments of Radiology (Drs. Hiraki, Mimura, Gobara, Iguchi, Fujiwara, Sakurai, Matsui, Inoue, and Kanazawa) and Cancer and Thoracic Surgery (Drs. Toyooka and Sano), Okayama University Medical School, Okayama, Japan.
Correspondence to:
Takao Hiraki, MD, Okayama University Medical School, Radiology, 2-5-1 Shikatacho Okayama, Okayama 700-8558, Japan; e-mail: [e-mail]

Abstract
Background: Although conventional CT scan-guided needle biopsy is an established diagnostic method for pulmonary lesions, few large studies have been conducted on the diagnostic outcomes of CT fluoroscopy-guided lung biopsy. We have conducted a retrospective analysis to evaluate the diagnostic outcomes of 1,000 CT fluoroscopy-guided lung biopsies performed with 20-gauge coaxial cutting needles.

Methods: We determined the diagnostic yield of CT fluoroscopy-guided lung biopsies performed with 20-gauge coaxial cutting needles for 1,000 lesions in 901 patients. Independent risk factors for diagnostic failure (ie, nondiagnostic, false-positive, and false-negative results) were determined with multivariate logistic regression analysis.

Results: The biopsy results were nondiagnostic in 0.6% of the lesions (6 of 1,000 lesions). The sensitivity and specificity for the diagnosis of malignancy was 94.2% (741 of 787 lesions) and 99.1% (211 of 213 lesions), respectively; diagnostic accuracy was 95.2% (952 of 1,000 lesions). For lesions measuring = 1.0 cm, the diagnostic accuracy was 92.7% (140 of 151 lesions). The significant independent risk factors for diagnostic failure were as follows: the acquisition of two or fewer specimens (odds ratio [OR], 2.43; p = 0.007), lesions in the lower lobe (OR, 2.50; p = 0.003), malignant lesions (OR, 7.16; p = 0.007), and lesions measuring = 1.0 cm (OR, 3.85; p = 0.016) and = 3.1 cm (OR, 4.32; p = 0.007).

Conclusions: CT fluoroscopy-guided lung biopsy performed with 20-gauge coaxial cutting needles resulted in a high diagnostic yield, even in the case of small lesions. Factors such as the acquisition of two or fewer specimens, lesions in the lower lobe, malignant lesions, and lesions measuring = 1.0 cm or = 3.1 cm significantly increased the rate of diagnostic failure.