Percutaneous Computed Tomography-Guided Lung Biopsies using a Virtual Navigation Guidance: Our Experience

Percutaneous CT-Guided Abdominal and Pelvic Biopsies: Comparison of an Electromagnetic Navigation System and CT Fluoroscopy

PURPOSE

To compare electromagnetic navigation (EMN) with computed tomography (CT) fluoroscopy for guiding percutaneous biopsies in the abdomen and pelvis.

MATERIALS AND METHODS

A retrospective matched-cohort design was used to compare biopsies in the abdomen and pelvis performed with EMN (consecutive cases, n = 50; CT-Navigation; Imactis, Saint-Martin-d'Hères, France) with those performed with CT fluoroscopy (n = 100). Cases were matched 1:2 (EMN:CT fluoroscopy) for target organ and lesion size (±10 mm).

RESULTS

The population was well-matched (age, 65 vs 65 years; target size, 2.0 vs 2.1 cm; skin-to-target distance, 11.4 vs 10.7 cm; P > .05, EMN vs CT fluoroscopy, respectively). Technical success (98% vs 100%), diagnostic yield (98% vs 95%), adverse events (2% vs 5%), and procedure time (33 minutes vs 31 minutes) were not statistically different (P > .05). Operator radiation dose was less with EMN than with CT fluoroscopy (0.04 vs 1.2 μGy; P < .001), but patient dose was greater (30.1 vs 9.6 mSv; P < .001) owing to more helical scans during EMN guidance (3.9 vs 2.1; P < .001). CT fluoroscopy was performed with a mean of 29.7 tap scans per case. In 3 (3%) cases, CT fluoroscopy was performed with gantry tilt, and the mean angle out of plane for EMN cases was 13.4°.

CONCLUSIONS

Percutaneous biopsies guided by EMN and CT fluoroscopy were closely matched for technical success, diagnostic yield, procedure time, and adverse events in a matched cohort of patients. EMN cases were more likely to be performed outside of the gantry plane. Radiation dose to the operator was higher with CT fluoroscopy, and patient radiation dose was higher with EMN. Further study with a wider array of procedures and anatomic locations is warranted.

Using 3D polylines to improve cone-beam CT-guided percutaneous transthoracic needle biopsy

OBJECTIVES

To investigate the diagnostic accuracy of using 3D polylines (3DPs) to improve cone-beam CT (CBCT) virtual navigation (VN)-guided percutaneous transthoracic needle biopsies (PTNB) of pulmonary lesions.

METHODS

From May 2021 to November 2021, patients (81 males and 41 females; age, 65 ± 12 years) who underwent CBCT VN with 3DPs for PTNB of pulmonary lesions were retrospectively reviewed. Fluoroscopic visibility of target lesions was evaluated using captured images from a Bull's eye view. Diagnostic accuracy was calculated, and complications were assessed.

RESULTS

The mean size of biopsied lesions was 23 ± 13 mm (range: 6-75 mm). Overall, 13.9% (17/122) were small pulmonary nodules (diameter ≤1 cm), and 68.0% (83/122) of biopsied lesions were fluoroscopic visible. The overall diagnostic accuracy was 94.3%. The diagnostic accuracy for visible and invisible lesions was 94.0 and 94.9%, respectively (p = 0.843), and 100% for small pulmonary nodules. Major complications occurred in 8.2% (10/122; eight pneumothorax with chest tube insertion, one hemoptysis with transfusion, and one air embolism) of patients.

CONCLUSION

CBCT VN with 3DP guidance provide a real-time outline of pulmonary lesions, thus enabling a reliable and accurate PTNB.

ADVANCES IN KNOWLEDGE

3DP guidance could be useful technique for CBCT-guided PTNB, especially in small pulmonary nodules.

Computed Tomography-Navigation™ Electromagnetic System Compared to Conventional Computed Tomography Guidance for Percutaneous Lung Biopsy: A Single-Center Experience

The aim of our study was to assess the efficacy of a computed tomography (CT)-Navigation™ electromagnetic system compared to conventional CT methods for percutaneous lung biopsies (PLB). In this single-center retrospective study, data of a CT-Navigation™ system guided PLB (NAV-group) and conventional CT PLB (CT-group) performed between January 2017 and February 2020 were reviewed. The primary endpoint was the diagnostic success. Secondary endpoints were technical success, total procedure duration, number of CT acquisitions and the dose length product (DLP) during step ∆1 (from planning to initial needle placement), step ∆2 (progression to target), and the entire intervention (from planning to final control) and complications. Additional parameters were recorded, such as the lesion’s size and trajectory angles. Sixty patients were included in each group. The lesions median size and median values of the two trajectory angles were significantly lower (20 vs. 29.5 mm, p = 0.006) and higher in the NAV-group (15.5° and 10° vs. 6° and 1°; p < 0.01), respectively. Technical and diagnostic success rates were similar in both groups, respectively 95% and 93.3% in the NAV-group, and 93.3% and 91.6% in the CT-group. There was no significant difference in total procedure duration (p = 0.487) and total number of CT acquisitions (p = 0.066), but the DLP was significantly lower in the NAV-group (p < 0.01). There was no significant difference in complication rate. For PLB, CT-Navigation™ system is efficient and safe as compared to the conventional CT method.

Impact of an Augmented Reality Navigation System (SIRIO) on Bone Percutaneous Procedures: A Comparative Analysis with Standard CT-Guided Technique

(1) Background: The purpose of this study is to evaluate the impact of an augmented reality navigation system (SIRIO) for percutaneous biopsies and ablative treatments on bone lesions, compared to a standard CT-guided technique. (2) Methods: Bioptic and ablative procedures on bone lesions were retrospectively analyzed. All procedures were divided into SIRIO and Non-SIRIO groups and in <2 cm and >2 cm groups. Number of CT-scans, procedural time and patient’s radiation dose were reported for each group. Diagnostic accuracy was obtained for bioptic procedures. (3) Results: One-hundred-ninety-three procedures were evaluated: 142 biopsies and 51 ablations. Seventy-four biopsy procedures were performed using SIRIO and 68 under standard CT-guidance; 27 ablative procedures were performed using SIRIO and 24 under standard CT-guidance. A statistically significant reduction in the number of CT-scans, procedural time and radiation dose was observed for percutaneous procedures performed using SIRIO, in both <2 cm and >2 cm groups. The greatest difference in all variables examined was found for procedures performed on lesions <2 cm. Higher diagnostic accuracy was found for all SIRIO-assisted biopsies. No major or minor complications occurred in any procedures. (4) Conclusions: The use of SIRIO significantly reduces the number of CT-scans, procedural time and patient’s radiation dose in CT-guided percutaneous bone procedures, particularly for lesions <2 cm. An improvement in diagnostic accuracy was also achieved in SIRIO-assisted biopsies.

[CT-guided Percutaneous Lung Puncture for the Diagnosis of Solid Pulmonary Nodules: A Single-center Experience Summary]

背景与目的

探究经皮肺穿刺对于实性肺小结节（直径≤15 mm）的诊断价值。

方法

本研究回顾性地纳入了2014年1月-2018年12月于本中心行经皮肺穿刺的20例实性肺小结节患者，其中男性11例，女性9例。病灶最大直径介于0.5 cm-1.5 cm之间，排除严重脏器功能不全，有凝血障碍患者。

结果

20例患者全部取材成功，19例患者均获得明确的病理诊断，其中11例患者找到恶性肿瘤细胞，明确为肺恶性肿瘤，5例为肺慢性炎，2例纤维组织增生，1例找到肺软骨组织，1例未见肿瘤细胞。穿刺后少量气胸1例，穿刺侧少量胸腔积液患者1例。

结论

经皮肺穿刺对于实性肺小结节的诊断具有较高的有效性以及安全性。