Using 3D polylines to improve cone-beam CT-guided percutaneous transthoracic needle biopsy

Objectives: To investigate the diagnostic accuracy of using 3D polylines (3DPs) to improve cone-beam CT (CBCT) virtual navigation (VN)-guided percutaneous transthoracic needle biopsies (PTNB) of pulmonary lesions. Methods: From May 2021 to November 2021, patients (81 males and 41 females; age, 65 ± 12 years) who under-went CBCT VN with 3DPs for PTNB of pulmonary lesions were retrospectively reviewed. Fluoroscopic visibility of target lesions was evaluated using captured images from a Bull’s eye view. Diagnostic accuracy was calcu-lated, and complications were assessed. Results: The mean size of biopsied lesions was 23 ± 13 mm (range: 6–75 mm). Overall, 13.9% (17/122) were small pulmonary nodules (diameter ≤1 cm), and 68.0% (83/122) of biopsied lesions were fluoroscopic visible. The overall diagnostic accuracy was 94.3%. The diagnostic accuracy for visible and invisible lesions was 94.0 and 94.9%, respectively (p = 0.843), and 100% for small pulmonary nodules. Major complications occurred in 8.2% (10/122; eight pneumothorax with chest tube insertion, one hemoptysis with transfusion, and one air embo-lism) of patients. Conclusion: CBCT VN with 3DP guidance provide a real-time outline of pulmonary lesions, thus enabling a reli-able and accurate PTNB. Advances in knowledge: 3DP guidance could be useful technique for CBCT-guided PTNB, especially in small pulmonary nodules.