From the Guidelines
CBCT-guided lung nodule biopsy is a highly effective and recommended procedure for diagnosing suspicious lung lesions, with the most recent study from 2023 1 demonstrating high diagnostic accuracy and reduced radiation exposure compared to conventional CT-guided biopsies. The procedure involves using cone beam computed tomography (CBCT) to guide a needle biopsy of lung nodules. CBCT provides real-time 3D imaging, allowing for precise needle placement and improved accuracy. Key steps in the procedure:
- Patient positioning and local anesthesia administration
- CBCT scan to locate the nodule
- Needle insertion under CBCT guidance
- Sample collection
- Post-procedure CBCT to check for complications Advantages:
- Higher diagnostic accuracy
- Reduced radiation exposure compared to conventional CT
- Ability to biopsy smaller and more challenging nodules
- Lower risk of complications Patients should fast for 6 hours before the procedure and inform their doctor of any medications, especially blood thinners. The procedure typically takes 30-60 minutes, and patients are usually discharged the same day with instructions to avoid strenuous activities for 24-48 hours. According to the 2023 study 1, the sensitivity of CBCT-guided lung nodule biopsy is high, with reported sensitivities of 95% and 99% for percutaneous core-needle biopsy. However, the study also notes that lower sensitivities were reported in studies analyzing nodules 15 mm or smaller. The most common complication of CBCT-guided lung nodule biopsy is pneumothorax, with reported rates ranging from 16% to 45% of cases, and pneumothorax requiring a chest tube in 1.8% to 15% of cases 1. Other reported risk factors for pneumothorax include older age, chronic obstructive pulmonary disease, and transversing fissures. A negative biopsy result does not exclude malignancy, but CBCT-guided lung nodule biopsy is valuable when a definite benign diagnosis is confirmed, as noted in the 2013 study 1. Overall, CBCT-guided lung nodule biopsy is a highly effective and recommended procedure for diagnosing suspicious lung lesions, with high diagnostic accuracy and reduced radiation exposure, and should be considered as a first-line diagnostic tool in clinical practice.
From the Research
Role of Cone Beam Computed Tomography (CBCT) in Guiding Lung Nodule Biopsies
- CBCT-guided percutaneous transthoracic needle biopsy (PTNB) is a highly accurate and safe diagnostic method for small (≤1 cm) lung nodules, with a sensitivity of 96.7%, specificity of 100%, and diagnostic accuracy of 98.0% 2.
- The use of CBCT guidance in lung nodule biopsies has been shown to have a low complication rate, with pneumothorax and hemoptysis occurring in 6.5% and 5.6% of cases, respectively 2.
- CBCT-guided PTNB has been compared to CT fluoroscopy-guided technique, with similar diagnostic performance and effective dose 3.
- A systematic review and meta-analysis of CBCT-guided PTNB found a pooled sensitivity of 0.96, specificity of 1.00, and diagnostic odds ratio of 16585.29, indicating high diagnostic accuracy 4.
- The incidence of complications, including pneumothorax and hemorrhage, has been reported to be 10-29.27% and 1.22-47.25%, respectively, in CBCT-guided PTNB 4.
- CBCT-guided PTNB has been shown to be a reliable and safe technique for the diagnosis of lung nodules, with a reasonable radiation exposure, and can be recommended for use in routine clinical practice 4.
- The diagnostic accuracy of CBCT-guided PTNB does not significantly decrease even in technically challenging conditions, such as small nodule size or deep location 5.