Technical Accuracy of Percutaneous Needle Biopsy of Subcentimeter Pulmonary Nodules under CT Fluoroscopy Guidance and Associated Procedural Complication

Introduction: According to the limited information in computed tomography (CT)-guided percutaneous core needle biopsy (PCNB) of subcentimeter 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.

Materials and Methods: A total of 156 cases with confirmed subcentimeter 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: 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 nondiagnostic pathology. Based on the analyses, male gender (p < 0.001), history of malignancy (p < 0.001), zone of lesions (lower zone [66.7%] vs. nonlower 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 approximately 32.5 ± 37.2 mGy/cm.

Conclusions: CT fluoroscopy-guided PCNB is a safe, effective, and precise method with minimal complication rates in pulmonary lesions of more than or equal to 6 to less than or equal to 10 mm size due to uncertainty in pathologic assessment of nodules less than 6 mm.