Computed Tomography Fluoroscopy-guided Biopsy of Lung Nodules: Comparison of the Step-wise and Realtime Techniques

The present study aimed to compare the step-wise and real-time techniques for computed tomography (CT) fluoroscopy-guided biopsy of lung nodules. It included 72 consecutive patients (50 men, 22 women; mean age: 71.8 years; range: 45–89 years) with lung nodules. Between March 2017 and April 2019, 72 CT fluoroscopy-guided biopsy procedures were performed using either the step-wise (n = 34) or real-time technique (n = 38). The diagnostic accuracy was 97.1% for biopsies performed using the step-wise technique and 94.7% for those performed using the real-time technique (p = 0.39). The mean CT dose index was 48.8 ± 16.9 mGy/s for the step-wise method and 59.9 ± 25.6 mGy/s for the real-time method; the dose length product was 1956 ± 729 mGy and 2613 ± 1300 mGy for the two techniques, respectively (p < 0.05). There was a significant difference in mean exposure time (81 ± 43 s for the step-wise technique and 162 ± 120 s for the real-time technique; p < 0.05). The mean lung nodule size was also significantly different (29.9 ± 17.6 mm for the step-wise method and 17.8 ± 12.2 mm for the real-time method; p < 0.01). Of the 34 step-wise procedures, 11 (32.4%) resulted in pneumothorax, as did 24 of 38 (63.2%) real-time procedures (p < 0.01). The real-time technique is particularly useful in patients with small nodules. The CT dose, exposure time, and incidence of pneumothorax were significantly lower when the step-wise technique was applied to CT fluoroscopy-guided biopsy of lung nodules.