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C-Arm Cone-Beam CT Virtual Navigation-Guided Percutaneous Mediastinal Mass Biopsy: Diagnostic Accuracy and Complications

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Abstract

Objectives

To assess the usefulness of C-arm cone-beam computed tomography (CBCT) virtual navigation-guided percutaneous mediastinal mass biopsy in terms of diagnostic accuracy and complication rates.

Methods

Seventy-eight CBCT virtual navigation-guided percutaneous mediastinal mass biopsies were performed in 75 patients (M:F, 38:37; mean age, 48.55 ± 18.76 years). The procedural details, diagnostic sensitivity, specificity, accuracy and complication rate were investigated.

Results

Mean lesion size was 6.80 ± 3.08 cm, skin-to-target distance was 3.67 ± 1.80 cm, core needle biopsy rate was 96.2 % (75/78), needle indwelling time was 9.29 ± 4.34 min, total procedure time was 13.26 ± 5.29 min, number of biopsy specimens obtained was 3.13 ± 1.02, number of CBCTs performed was 3.03 ± 0.68, rate of lesion border discrimination from abutting mediastinal structures on CBCT was 26.9 % (21/78), technical success rate was 100 % (78/78), estimated effective dose was 5.33 ± 4.99 mSv, and the dose area product was 12,723.68 ± 10,665.74 mGy⋅cm2. Among the 78 biopsies, 69 were malignant, 7 were benign and 2 were indeterminate. Diagnostic sensitivity, specificity and accuracy for the diagnosis of malignancies were 97.1 % (67/69), 100 % (7/7) and 97.4 % (74/76), respectively, with a complication rate of 3.85 % (3/78), all of which were small pneumothoraces.

Conclusions

CBCT virtual navigation-guided biopsy is a highly accurate and safe procedure for the evaluation of mediastinal lesions.

Key Points

• CBCT virtual navigation-guided percutaneous mediastinal biopsy is highly accurate

• CBCT virtual navigation-guided percutaneous mediastinal biopsy is a safe procedure

• Mediastinal vascular injury can be avoided under CBCT virtual navigation guidance

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Abbreviations

CBCT:

Cone-beam computed tomography

3D:

Three-dimensional

DLBL:

Diffuse large B-cell lymphoma

DAP:

Dose area product

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Acknowledgments

The scientific guarantor of this publication is Chang Min Park, MD, Ph.D. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. This work was supported by the Industrial Strategic Technology Development Program (grant number: 10041618) funded by the Ministry of Trade Industry and Energy (MI, Korea). No complex statistical methods were necessary for this paper. Institutional review board approval was obtained. Written informed consent was waived by the institutional review board. Study subjects have not been previously reported in other journals. Methodology: retrospective, diagnostic study (case series), performed at one institution.

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Authors and Affiliations

  1. Department of Radiology, Seoul National University College of Medicine, 101, Daehangno, Jongno-gu, Seoul, 110-744, Korea

    Hyungjin Kim, Chang Min Park, Sang Min Lee & Jin Mo Goo

  2. Institute of Radiation Medicine, Seoul National University Medical Research Center, 101, Daehangno, Jongno-gu, Seoul, 110-744, Korea

    Hyungjin Kim, Chang Min Park, Sang Min Lee & Jin Mo Goo

  3. Aerospace Medical Group, Air Force Education and Training Command, Jinju, Korea

    Hyungjin Kim

  4. Cancer Research Institute, Seoul National University, 101, Daehangno, Jongno-gu, Seoul, 110-744, Korea

    Chang Min Park & Jin Mo Goo

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  1. Hyungjin Kim
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Correspondence to Chang Min Park.

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Kim, H., Park, C.M., Lee, S.M. et al. C-Arm Cone-Beam CT Virtual Navigation-Guided Percutaneous Mediastinal Mass Biopsy: Diagnostic Accuracy and Complications. Eur Radiol 25, 3508–3517 (2015). https://doi.org/10.1007/s00330-015-3762-8

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