Skip to main content

Advertisement

SpringerLink
Log in

Comparison Between CBCT and Fusion PET/CT-CBCT Guidance for Lung Biopsies

  • Clinical Investigation
  • Interventional Oncology
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Purpose

To establish the feasibility of performing percutaneous biopsy of lung lesions guided by fusion PET/CT-CBCT and to evaluate whether the metabolic information provided by a prior PET/CT scan add incremental benefits for diagnosis.

Methods

We retrospectively reviewed data from 180 patients who underwent CBCT-guided lung biopsy (group 1—90 cases) or PET/CT-CBCT fusion-guided lung biopsy (group 2—90 cases). Technical and clinical success was calculated. We also evaluated the agreement between biopsy and definitive histology and the possibility to carrying out immunehistochemical and molecular biology analyses.

Results

Technical success was achieved in 84/90 (93.3%) cases for group 1 and 89/90 (98.9%) for group 2 cases (p 0.054). Clinical success was achieved in 80/94 (95.2%) cases for group 1 and 88/89 (98.9%) cases for group 2. Sensitivity, specificity, positive and negative predictive values and accuracy rate were, respectively, 94.5%, 100.0%, 100.0%, 73.3% and 95.2% for group 1 and 98.6%, 100.0%, 100.0%, 94.4% and 98.9% for group 2 (p 0.167). Agreement between biopsy and definitive histology was reached in 85.7% for group 1 and in 96.2% for group 2 (p 0.211). Immunohistochemical and molecular biology investigations were possible in 66.7% for group 1 and in 77.0% for group 2 (p 0.297). No major complication occurred.

Conclusions

PET/CT-CBCT-guided lung biopsy is a feasible technique. In our retrospective case series, we found a higher clinical success rate, but no statistical difference was found.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Veltri A, Bargellini I, Giorgi L, Almeida PAMS, Akhan O. CIRSE guidelines on percutaneous needle biopsy (PNB). Cardiovasc Interv Radiol. 2017;40(10):1501–3. https://doi.org/10.1007/s00270-017-1658-5.

    Article  Google Scholar 

  2. El-Haddad G. PET-Based percutaneous needle biopsy. PET Clin. 2016;11(3):333–49. https://doi.org/10.1016/j.cpet.2016.02.009.

    Article  PubMed  Google Scholar 

  3. Floridi C, Muollo A, Fontana F, Rotolo N, Ierardi AM, Duka E, Pellegrino C, Carrafiello G. C-arm cone-beam computed tomography needle path overlay for percutaneous biopsy of pulmonary nodules. Radiol Med. 2014;119(11):820–7. https://doi.org/10.1007/s11547-014-0406-z.

    Article  PubMed  Google Scholar 

  4. Abi-Jaoudeh N, Mielekamp P, Noordhoek N, Venkatesan AM, Millo C, Radaelli A, Carelsen B, Wood BJ. Cone-beam computed tomography fusion and navigation for real-time positron emission tomography-guided biopsies and ablations: a feasibility study. J Vasc Interv Radiol. 2012;23(6):737–43. https://doi.org/10.1016/j.jvir.2012.02.006.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Floridi C, Carnevale A, Fumarola EM, et al. Percutaneous lung tumor biopsy under CBCT guidance with PET-CT fusion imaging: preliminary experience. Cardiovasc Interv Radiol. 2019;42(11):1644–8. https://doi.org/10.1007/s00270-019-02270-1.

    Article  CAS  Google Scholar 

  6. Filippiadis DK, Binkert C, Pellerin O, Hoffmann RT, Krajina A, Pereira PL. Cirse quality assurance document and standards for classification of complications: the cirse classification system. Cardiovasc Interv Radiol. 2017;40(8):1141–6. https://doi.org/10.1007/s00270-017-1703-4.

    Article  CAS  Google Scholar 

  7. Fanchon LM, Dogan S, Moreira AL, et al. Feasibility of in situ, high-resolution correlation of tracer uptake with histopathology by quantitative autoradiography of biopsy specimens obtained under 18F-FDG PET/CT guidance. J Nucl Med. 2015;56(4):538–44. https://doi.org/10.2967/jnumed.114.148668.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Tatli S, Gerbaudo VH, Mamede M, Tuncali K, Shyn PB, Silverman SG. Abdominal masses sampled at PET/CT-guided percutaneous biopsy: initial experience with registration of prior PET/CT images. Radiology. 2010;256(1):305–11. https://doi.org/10.1148/radiol.10090931.

    Article  PubMed  Google Scholar 

  9. Purandare NC, Kulkarni AV, Kulkarni SS, et al. 18F-FDG PET/CT-directed biopsy: does it offer incremental benefit? Nucl Med Commun. 2013;34(3):203–10. https://doi.org/10.1097/MNM.0b013e32835c5a57.

    Article  CAS  PubMed  Google Scholar 

  10. Guo W, Hao B, Chen HJ, et al. PET/CT-guided percutaneous biopsy of FDG-avid metastatic bone lesions in patients with advanced lung cancer: a safe and effective technique. Eur J Nucl Med Mol Imaging. 2017;44(1):25–322. https://doi.org/10.1007/s00259-016-3455-9.

    Article  CAS  PubMed  Google Scholar 

  11. Venkatesan AM, Kadoury S, Abi-Jaoudeh N, et al. Real-time FDG PET guidance during biopsies and radiofrequency ablation using multimodality fusion with electromagnetic navigation. Radiology. 2011;260(3):848–56. https://doi.org/10.1148/radiol.11101985.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Klaeser B, Wiskirchen J, Wartenberg J, et al. PET/CT-guided biopsies of metabolically active bone lesions: applications and clinical impact. Eur J Nucl Med Mol Imaging. 2010;37(11):2027–36. https://doi.org/10.1007/s00259-010-1524-z.

    Article  PubMed  Google Scholar 

  13. Tatli S, Gerbaudo VH, Feeley CM, Shyn PB, Tuncali K, Silverman SG. PET/CT-guided percutaneous biopsy of abdominal masses: initial experience. J Vasc Interv Radiol. 2011;22(4):507–14. https://doi.org/10.1016/j.jvir.2010.12.035.

    Article  PubMed  Google Scholar 

  14. Cornelis F, Silk M, Schoder H, et al. Performance of intra-procedural 18-fluorodeoxyglucose PET/CT-guided biopsies for lesions suspected of malignancy but poorly visualized with other modalities. Eur J Nucl Med Mol Imaging. 2014;41(12):2265–72. https://doi.org/10.1007/s00259-014-2852-1.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Aparici CM, Aslam R, Win AZ. Initial experience of utilizing real-time intra-procedural PET/CT biopsy. J Clin Imaging Sci. 2014;4:54. https://doi.org/10.4103/2156-7514.141941.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Radhakrishnan RK, Mittal BR, Gorla AKR, et al. Real-time intra-procedural 18F-FDG PET/CT-guided biopsy using automated robopsy arm (ARA) in the diagnostic evaluation of thoracic lesions with prior inconclusive biopsy results: initial experience from a tertiary health care centre. Br J Radiol. 2017;90(1080):20170258. https://doi.org/10.1259/bjr.20170258.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Cerci JJ, Tabacchi E, Bogoni M, et al. Comparison of CT and PET/CT for biopsy guidance in oncological patients. Eur J Nucl Med Mol Imaging. 2017;44(8):1269–74. https://doi.org/10.1007/s00259-017-3658-8.

    Article  PubMed  Google Scholar 

  18. Yan GW, Bhetuwal A, Yan GW, et al. A systematic review and meta-analysis of c-arm cone-beam CT-guided percutaneous transthoracic needle biopsy of lung nodules. Pol J Radiol. 2017;82:152–60. https://doi.org/10.12659/PJR.899626.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

This study was not supported by any funding.

Author information

Authors and Affiliations

  1. Diagnostic and Interventional Radiology Department, Ospedale di Circolo e Fondazione Macchi, ASST dei Sette Laghi, Via Guicciardini, 9, 21100, Varese, Italy

    Federico Fontana, Filippo Piacentino, Andrea Coppola & Massimo Venturini

  2. Università degli Studi dell’Insubria, Varese, Italy

    Federico Fontana, Andrea Selenito Imperatori, Giulio Carcano & Massimo Venturini

  3. Diagnostic and Interventional Radiology Department, ASST Santi Paolo e Carlo, San Paolo Hospital, Milan, Italy

    Anna Maria Ierardi & Gianpaolo Carrafiello

  4. Università degli Studi di Milano, Milan, Italy

    Anna Maria Ierardi & Gianpaolo Carrafiello

  5. Radiology Department, Ospedale di Legnano, ASST Ovest Milanese, Legnano, MI, Italy

    Alessandra Muollo

  6. Diagnostic and Interventional Radiology Department, Ospedale Sant’Anna, ASST Lariana, Como, Italy

    Alessandro Beneventi

  7. Università Politecnica delle Marche, Ancona, Italy

    Chiara Floridi

  8. Thoracic Surgery Department, Ospedale di Circolo e Fondazione Macchi, ASST dei Sette Laghi, Varese, Italy

    Andrea Selenito Imperatori

  9. Surgery Department, Ospedale di Circolo e Fondazione Macchi, ASST dei Sette Laghi, Varese, Italy

    Giulio Carcano

Authors
  1. Federico Fontana
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Filippo Piacentino
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Anna Maria Ierardi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gianpaolo Carrafiello
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Andrea Coppola
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Alessandra Muollo
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Alessandro Beneventi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Chiara Floridi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Andrea Selenito Imperatori
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Giulio Carcano
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Massimo Venturini
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Andrea Coppola.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

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

Informed Consent

For this type of study, informed consent is not required

Human and Animal Rights

This article does not contain any studies with animals performed by any of the authors.

Consent for Publication

For this type of study, consent for publication is not required.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fontana, F., Piacentino, F., Ierardi, A.M. et al. Comparison Between CBCT and Fusion PET/CT-CBCT Guidance for Lung Biopsies. Cardiovasc Intervent Radiol 44, 73–79 (2021). https://doi.org/10.1007/s00270-020-02613-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00270-020-02613-3

Keywords

Search

Navigation