1Alireza Abrishami,2Yasaman Nasrollahpoor, 3Yasaman Nasrollahpoor, 2Pankaj Kafle, 2Mahsa Alborzi Avanaki, 4Mahsa Alborzi Avanaki

1Department of Radiology, Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, 2Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, 3Shahid Beheshti University of Medical Sciences, 4Sirjan School of Medical Sciences

Background(s):

According to the limited information in Computed tomography (CT)-guided percutaneous core needle biopsy (PCNB) of sub-centimeter pulmonary nodules with radiation burden to the patients and operator for diagnosis of lung lesions as benign or malignant, we aimed to evaluate the accuracy rate of CT fluoroscopy-guided biopsy in these nodules.

Material(s) and Method(s):

A total of 156 cases with confirmed sub-centimeter pulmonary nodules were enrolled in this retrospective study from January 2019 to December 2021. Demographic data, past history of malignancy, nodules’ CT features and location, total dose length product (DLP), smart DLP, and associated complications were recorded; then, the relationship of all characteristics with certainty in pathology was assessed. Under CT fluoroscopy-guided, PCNB was performed through the nearest marker to the target lesion with the proper body position. Eventually, a control low dose lung CT scan was done to observe complications.

Result(s):

Mean age of patients was 56.7±12.3 years (range=22-82, female=97(62.2%). Mean nodule number was 4.6±5.6(range:1-15) and most patients had only one nodule (82;52.6%). Totally 124(79.5%) samples yielded a definite diagnosis [benign=84(53.8%), malignant=40(25.6%)], while 32(20.5%) cases showed non-diagnostic pathology. Based on the analyses, male gender (p<0.001), history of malignancy (p<0.001), zone of lesions [lower zone(66.7%) vs. non-lower zone(83.3%), p=0.03] and lesion size [lesions <6mm(48%) vs. ≥6mm(85.5%), p<0.001] were statistically associated with certainty in pathology. Regarding complications, patients with hemoptysis had greater nodule distance (31.7±15.5mm vs. 18.8±14.4, p=0.001) from the pleura(p=0.001). Smart DLP was about 32.5±37.2 mGy/cm.

Conclusion(s):

CT fluoroscopy-guided PCNB is a safe, effective, and precise method with minimal complication rates in pulmonary lesions of  ≥6mm to ≤10mm size due to uncertainty in pathologic assessment of nodules<6mm