P2.04-028 Cone-Beam CT Virtual Navigation-Guided Percutaneous Needle Biopsy of Suspicious Pleural Metastasis: Initial Experience: Topic: Esophageal Cancer and Other Malignancies

Among pleural lesions showing diffuse or nodular thickenings, malignancies, particularly metastases, have been shown to be more common than benign diseases. Since the diagnosis of pleural metastasis can prevent unnecessary surgical interventions in oncologic patients, the accurate diagnosis of pleural metastasis would be of great clinical importance. Pathologic diagnosis with solid tissue samples remains critical for this, particularly for cytology negative cases. Recently, cone-beam CT (CBCT) was introduced to the field of radiologic intervention and improved the diagnostic accuracy and efficacy of percutaneous transthoracic needle biopsy of lung nodules and mediastinal masses. In addition, the CBCT virtual navigation software program is able to provide a virtual needle pathway leading to better targeting of lesions, helping operators more easily navigate the needle into the target after initially determining the skin entry site and destination target based on pre-procedural CBCT data. Yet, CBCT virtual navigation has not been investigated for pleural biopsy. Therefore, we aimed to assess the usefulness of the CBCT virtual navigation system for percutaneous biopsy of pleural lesions with regard to its diagnostic accuracy and complication rates for clinically or radiologically suspected pleural metastasis. This retrospective study was approved by our institutional review board with waiver of patients’ informed consent. From December 2010 to April 2016, 38 CBCT virtual navigation-guided pleural biopsies were performed in 36 patients (M:F=19:17; mean age, 64.61 years ± 12.67) with clinically or radiologically suspected pleural metastasis. A coaxial system with 18- or 20-gauge cutting needles was used. Procedural details, diagnostic performance, radiation exposure and complication rates were investigated. Mean diameter perpendicular to the pleura of 32 focal and 6 diffuse pleural lesions was 1.54 cm ± 0.84. Mean distance from the skin to the target was 3.43 cm ± 1.48. Mean number of CT acquisitions, biopsies, total procedure time, coaxial introducer indwelling time, and estimated radiation exposure were 3.21 ± 0.57, 3.05 ± 1.54, 11.87 min ± 5.59, 8.78 min ± 4.95, and 5.77 mSv ± 4.31, respectively. There were 28 malignant (73.7%), 9 benign (23.7%), and 1 indeterminate (2.6%) lesions. Sensitivity, specificity, and diagnostic accuracy of CBCT virtual navigation-guided pleural biopsy were 96.4% (27/28), 100% (9/9) and 97.3% (36/37), respectively. Positive and negative predictive values for malignancy were 100% (27/27) and 90% (9/10), respectively. There were no procedure-related complications. CBCT virtual navigation-guided pleural biopsy is a highly accurate and safe diagnostic technique for suspicious pleural metastasis with reasonable radiation exposure and procedure time.