Computed tomography-guided core needle biopsy for lung nodules: low-dose versus standard-dose protocols

Introduction: Computed tomography (CT)-guided core needle biopsy (CNB) is an essential step in the management of lung nodules (LNs). Low-dose CT (LDCT)-guided CNB has been used to decrease the radiation exposure. Aim: To evaluate the technical success, safety, diagnostic capacity, and radiation exposure to patients between LDCT-guided and standard-dose CT (SDCT)-guided CNB for LNs. Material and methods: This is a retrospective, single-centre study. Patients who underwent LDCT-guided or SDCT-guided CNB for LNs from January 2015 to December 2017 were included. Data on technical success, diagnostic performance, complications, and radiation exposure were collected and analysed. Results: A total of 70 and 65 patients underwent LDCT-guided and SDCT-guided CNB procedure, respectively. The technical success rates were 100% in both groups. The diagnostic yield, sensitivity, specificity, and overall diagnostic accuracy in the LDCT and SDCT groups were 71.4% and 67.7% (p = 0.637), 97.8% and 93.2% (p = 0.625), 100%, and 100%, and 98.6% and 95.4% (p = 0.560), respectively. The independent risk factor of diagnostic failure was less sample tissues (p = 0.012; 95% confidence interval: 0.033-0.651). Pneumothorax was found in 9 and 12 patients in the LDCT and SDCT groups, respectively (p = 0.369). Lung haemorrhage was found in 11 and 12 patients in the LDCT and SDCT groups, respectively (p = 0.671). The mean dose-length product was 38.3 +/- 17.0 mGy . cm and 376.0 +/- 118.7 mGy . cm in the LDCT and SDCT groups, respectively (p < 0.001). Conclusions: Compared to SDCT, LDCT-guided CNB can provide comparable safety and diagnostic performance for LNs while reducing exposure to radiation.

Automated summary

LDCT-guided core needle biopsy for lung nodules shows comparable safety and diagnostic performance to SDCT-guided biopsy, while significantly reducing radiation exposure to patients.