Fior Davide, Vacirca Francesco, Leni Davide, Pagni Fabio, Ippolito Davide, Riva Luca, Sironi Sandro, Corso Rocco
Department of Diagnostic and Interventional Radiology, "San Gerardo" Hospital, Via Pergolesi 33, 20900, Monza, MB, Italy.
School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, MB, Italy.
Cardiovasc Intervent Radiol. 2019 May;42(5):712-719. doi: 10.1007/s00270-019-02163-3. Epub 2019 Jan 16.
C-arm cone-beam computed tomography-guided transthoracic lung core needle biopsy (CBCT-CNB) is a safe and accurate procedure for the evaluation of patients with pulmonary nodules. The purpose of our study was to evaluate the diagnostic performance, complication rates and effective radiation dose of CBCT-CNB with virtual guidance.
We retrospectively collected data regarding 375 CBCT-CNBs performed with virtual guidance (XperGuide-Philips Healthcare, Best, The Netherlands) from January 2010 to June 2015 on 355 patients (mean age, 68.1 years ± 11.8; age range, 31-88 years). Patients were divided into groups and compared based on the diagnostic failure and lesion size (15 mm cutoff). Diagnostic performance, complication rate and effective radiation dose were investigated. Variables influencing diagnostic performance and complications were assessed using Student's T test and Pearson's χ test.
The sensitivity, specificity, positive and negative predictive value and accuracy for patients subjected to CNBs were 96.8%, 100%, 100%, 100% and 97.2%, respectively. Considering risk factors for pneumothorax, no significant differences were found regarding patient and lesion characteristics. Perilesional hemorrhage occurred more frequently in older patients (p = 0.046) and in smaller lesions (p = 0.001). Hemoptysis was significantly more frequent in patients with perilesional hemorrhage (p = 0.01). Mean effective radiation dose in CBCT-CNB was 7.12 ± 8.78 mSv.
CBCT-CNB combined with virtual guidance is a reliable and accurate technique that allows exact localization of pulmonary lesions, effective preprocedural planning and real-time fluoroscopy altogether.
C形臂锥束计算机断层扫描引导下经胸肺芯针穿刺活检（CBCT-CNB）是评估肺结节患者的一种安全且准确的方法。我们研究的目的是评估虚拟引导下CBCT-CNB的诊断性能、并发症发生率及有效辐射剂量。
我们回顾性收集了2010年1月至2015年6月期间对355例患者（平均年龄68.1岁±11.8；年龄范围31-88岁）进行的375例虚拟引导下（XperGuide-飞利浦医疗，荷兰贝斯特）CBCT-CNB的数据。根据诊断失败情况和病变大小（以15毫米为界）将患者分组并进行比较。研究诊断性能、并发症发生率及有效辐射剂量。使用学生t检验和皮尔逊χ检验评估影响诊断性能和并发症的变量。
接受CNB的患者的敏感性、特异性、阳性和阴性预测值及准确率分别为96.8%、100%、100%、100%和97.2%。考虑气胸的危险因素，在患者和病变特征方面未发现显著差异。病灶周围出血在老年患者（p = 0.046）和较小病变（p = 0.001）中更常见。病灶周围出血的患者咯血明显更频繁（p = 0.01）。CBCT-CNB的平均有效辐射剂量为7.12±8.78 mSv。
CBCT-CNB联合虚拟引导是一种可靠且准确的技术，可实现肺部病变的精确定位、有效的术前规划和实时透视。
