Abstract
This study investigated the method and clinical value of percutaneous needle biopsy of the thoracic region using a combination of cone-beam computed tomography (CBCT) equipped with a flat panel detector for digital subtraction angiography (DSA) and fluoroscopy. In 77 patients with a total of 79 lesions in the thoracic region (67 in the lung field, 6 in the mediastinum, and 6 in the chest wall), CT-like images of the lesions were acquired by CBCT, and needle biopsy was performed with fluoroscopic guidance. Puncture of the mass via the planned route was possible in all cases, and specimens of a sufficient size for pathological diagnosis could be biopsied. Only slight adjustments of the puncture site and angle were made under fluoroscopy. The final diagnosis of the biopsied specimen was malignant disease in 70 of the 77 patients (90.9%) ; 54 of the 77 patients (70.1%) had primary lung cancer and in 4 of the 77 patients (5.2%) had metastatic tumor. The histological type of the primary lung cancer was adenocarcinoma in 26 of the 77 patients (33.8%), squamous cell carcinoma in 22 of the 77 patients (28.6%), and small cell carcinoma in 6 of the 77 patients (7.8%). Complications occurred in 31 of the 77 patients (40.3%), comprising pneumothorax and pulmonary hemorrhage, but no fatal complications such as air embolism or the dissemination of malignant cells eventuated. In addition, unlike CT-guided biopsy, the described procedure requires only an angiography room. This method enables reliable biopsy using 3-dimensional data, and is a promising percutaneous biopsy method.
