Medical Oncology

, 34:17 | Cite as

Extra-pleuric coaxial system for CT-guided percutaneous fine-needle aspiration biopsy (FNAB) of small (≤20 mm) lung nodules: a novel technique using multiplanar reconstruction (MPR) images

  • Raffaella CapassoEmail author
  • Rita Nizzoli
  • Marcello Tiseo
  • Giuseppe Pedrazzi
  • Luca Brunese
  • Antonio Rotondo
  • Massimo De Filippo
Original Paper
Part of the following topical collections:
  1. New Advances in Interventional Oncology: State of the Art


The aim of the study is to present the diagnostic feasibility, usefulness, and safety of a novel technique for coaxial CT-guided fine-needle aspiration biopsy of small (≤20 mm in diameter) lung nodules. A 18-gauge (G) (1.2 × 40 mm) needle is inserted through the skin in the depth of the thoracic wall tissues remaining outside the pleura. Its positioning is planned and adjusted using multiplanar reconstruction (MPR) images along the 18-G guide needle axis tracing a reference outline extended from the needle tip to the target nodule. When the insertion of the 18-G extra-pleuric needle (EPN) proves to be precise, a 22-G Chiba needle is then passed through the outer 18-G EPN until it reaches the thoracic lesion for the sampling procedure. Patient population included 153 males and 94 females, with a mean age of 61.3 ± 21.6 years. Mean nodule diameter was 14.1 ± 2.2 mm. The lesion depth from pleural plane ranged from 0 mm to 127 mm. An average of 1.29 aspirates were performed per lesion. The most common complication was pneumothorax in 27 cases; there were no cases of PNX requiring chest tube insertion. Intrapulmonary bleeding along the needle track was observed in 32 patients. Exploiting the advantage of MPR images, our novel technique of extra-pleuric coaxial system with a 18-G EPN allows the operator to multiple samplings of small (≤20 mm) target lesions in various locations with a thinner (22-G Chiba) needle, thus reducing the degree of pleural, parenchymal, or adjacent organs damage.


Coaxial technique Lung biopsy CT guidance Small nodule Pneumothorax MPR 



Computed tomography


Extra-pleuric needle


Fine-needle aspiration biopsy




Multidetector CT


Multiplanar reconstruction




Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Patient consent

Informed consent was obtained from all patients before diagnostic examination.

Financial disclosure

The authors have no financial relationships relevant to this article to disclose.


  1. 1.
    Otto S, Mensel B, Friedrich N, Schäfer S, Mahlke C, von Bernstorff W, et al. Predictors of technical success and rate of complications of image-guided percutaneous transthoracic lung needle biopsy of pulmonary tumors. PLoS ONE. 2015;10:e0124947.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Rui H, Nan-Chuan J, Hao-Hao L, Yu-Hui W, Li H, He-Shui S, et al. Precision of coaxial needle placement in computed tomography-guided transthoracic needle biopsy. Exp Ther Med. 2013;6:1307–11.Google Scholar
  3. 3.
    Ierardi AM, Mangini M, Fontana F, Floridi C, De Marchi G, Petrillo M, et al. Usefulness and safety of biliary percutaneous transluminal forceps biopsy (PTFB): our experience. Minim Invasive Ther Allied Technol. 2014;23:96–101.CrossRefPubMedGoogle Scholar
  4. 4.
    Sa YJ, Kim JJ, Du Kim Y, Sim SB, Moon SW. A new protocol for concomitant needle aspiration biopsy and localization of solitary pulmonary nodules. J Cardiothorac Surg. 2015;10:104.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Schulze R, Seebacher G, Enderes B, Kugler G, Fischer JR, Graeter TP. Complications in CT-guided, semi-automatic coaxial core biopsy of potentially malignant pulmonary lesions. RöFo Fortschr auf dem Geb der Röntgenstr und der Nukl. 2015;187:697–702.CrossRefGoogle Scholar
  6. 6.
    Yaffe D, Koslow M, Haskiya H, Shitrit D. A novel technique for CT-guided transthoracic biopsy of lung lesions: improved biopsy accuracy and safety. Eur Radiol. 2015;25(11):3354–60.CrossRefPubMedGoogle Scholar
  7. 7.
    De Filippo M, Onniboni M, Rusca M, Carbognani P, Ferrari L, Guazzi A, et al. Advantages of multidetector-row CT with multiplanar reformation in guiding percutaneous lung biopsies. Radiol Med. 2008;113:945–53.CrossRefPubMedGoogle Scholar
  8. 8.
    Li Y, Du Y, Yang HF, Yu JH, Xu XX. CT-guided percutaneous core needle biopsy for small (≤20 mm) pulmonary lesions. Clin Radiol. 2013;68:e43–8.CrossRefPubMedGoogle Scholar
  9. 9.
    Rotolo N, Floridi C, Imperatori A, Fontana F, Ierardi AM, Mangini M, et al. Comparison of cone-beam CT-guided and CT fluoroscopy-guided transthoracic needle biopsy of lung nodules. Eur Radiol. 2016;26:381–9.CrossRefPubMedGoogle Scholar
  10. 10.
    De Filippo M, Saba L, Rossi E, Nizzoli R, Tiseo M, Pedrazzi G, et al. Curved needles in CT-guided fine needle biopsies of abdominal and retroperitoneal small lesions. Cardiovasc Intervent Radiol. 2015;38:1611–6.CrossRefPubMedGoogle Scholar
  11. 11.
    De FilippoM, Saba L, Silva M, Zagaria R, Concari G, Nizzoli R, et al. CT-guided biopsy of pulmonary nodules: is pulmonary hemorrhage a complication or an advantage? Diagn Interv Radiol. 2014;20:421–5.CrossRefGoogle Scholar
  12. 12.
    De Filippo M, Saba L, Azzali E, Milanese G, Mostardi M, Borgia D, et al. CT-guided fine-needle aspiration of abdominal and retroperitoneal small lesions with the coaxial technique using MPR images. Acta Biomed. 2016;87(Suppl 3):57–62.PubMedGoogle Scholar
  13. 13.
    Reginelli A, Rossi C, Capasso R, Urraro F, Cagini L, Di Crescenzo V, et al. Evaluation with multislice CT of the hilar pulmonary nodules for probable infiltration of vascular-bronchial structures. Recenti Prog Med. 2013;104:403–5.PubMedGoogle Scholar
  14. 14.
    De Filippo M, Saba L, Concari G, Nizzoli R, Ferrari L, Tiseo M, et al. Predictive factors of diagnostic accuracy of CT-guided transthoracic fine-needle aspiration for solid noncalcified, subsolid and mixed pulmonary nodules. Radiol Med. 2013;118:1071–81.CrossRefPubMedGoogle Scholar
  15. 15.
    Guimaraes M, Marchiori E, Hochhegger B, Chojniak R, Gross J. CT-guided biopsy of lung lesions: defining the best needle option for a specific diagnosis. Clinics. 2014;69:335–40.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Nour-Eldin N-EA, Alsubhi M, Emam A, Lehnert T, Beeres M, Jacobi V, et al. Pneumothorax complicating coaxial and non-coaxial CT-guided lung biopsy: comparative analysis of determining risk factors and management of pneumothorax in a retrospective review of 650 patients. Cardiovasc Intervent Radiol. 2016;39(2):261–70.CrossRefPubMedGoogle Scholar
  17. 17.
    Geraghty PR, Kee ST, McFarlane G, Razavi MK, Sze DY, Dake MD. CT-guided transthoracic needle aspiration biopsy of pulmonary nodules: needle size and pneumothorax rate. Radiology. 2003;229:475–81.CrossRefPubMedGoogle Scholar
  18. 18.
    Carrafiello G, Mangini M, Fontana F, Di Massa A, Ierardi AM, Cotta E, et al. Complications of microwave and radiofrequency lung ablation: personal experience and review of the literature. Radiol Med. 2012;117(2):201–13.CrossRefPubMedGoogle Scholar
  19. 19.
    Kuban JD, Tam AL, Huang SY, Ensor JE, Philip AS, Chen GJ, et al. The effect of needle gauge on the risk of pneumothorax and chest tube placement after percutaneous computed tomographic (CT)-guided lung biopsy. Cardiovasc Intervent Radiol. 2015;38:1595–602.CrossRefPubMedGoogle Scholar
  20. 20.
    Priola AM, Priola SM, Cataldi A, Di Franco M, Pazè F, Marci V, et al. Diagnostic accuracy and complication rate of CT-guided fine needle aspiration biopsy of lung lesions: a study based on the experience of the cytopathologist. Acta Radiol. 2010;51:527–33.CrossRefPubMedGoogle Scholar
  21. 21.
    Ko JP, Shepard JO, Drucker EA, Aquino SL, Sharma A, Sabloff B, et al. Factors influencing pneumothorax rate at lung biopsy: are dwell time and angle of pleural puncture contributing factors? Radiology. 2001;218:491–6.CrossRefPubMedGoogle Scholar
  22. 22.
    Yeow KM, Su IH, Pan KT, Tsay PK, Lui KW, Cheung YC, et al. Risk factors of pneumothorax and bleeding: Multivariate analysis of 660 CT-guided coaxial cutting needle lung biopsies. Chest. 2004;126:748–54.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  1. 1.Department of Medicine and Health Sciences “V. Tiberio”University of MoliseCampobassoItaly
  2. 2.Medical Oncology UnitUniversity Hospital of ParmaParmaItaly
  3. 3.Department of NeuroscienceUniversity of ParmaParmaItaly
  4. 4.Department of Internal and Experimental Medicine, Magrassi-LanzaraSecond University of NaplesNaplesItaly
  5. 5.Department of RadiologyUniversity of Parma, Parma HospitalParmaItaly

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