Authors (including presenting author) :
Tam HL, Lee MC, Chiu KWH, Lee JCY, Shek KW, Poon WL
Affiliation :
Department of Diagnostic and Interventional Radiology, Queen Elizabeth Hospital
Introduction :
Lung cancer is the leading cause of cancer deaths in Hong Kong. Image-guided biopsy is essential for histopathological diagnosis and molecular profiling. While conventional computed tomography (CT)-guided lung biopsy is the routine practice, there are long waiting times due to competing demands for CT scanners between diagnostics and interventions. With the advent of cone-beam computed tomography (CBCT), fluoroscopic-guided lung biopsy, a largely forgotten technique, can now achieve lesion localization and needle placement comparable to CT guidance.
Objectives :
We herein present our initial experience with CBCT/fluoroscopic-guided lung biopsy, a service commenced in November 2022 to tackle the growing demands of lung cancer diagnosis.
Methodology :
A retrospective analysis was conducted on patients who underwent imaged-guided lung biopsy at Queen Elizabeth Hospital between 2022 to 2024. We explored the impact to clinical service and wait times after commencing the CBCT/fluoroscopic-guided lung biopsy service. In addition, we reviewed the patient demographics, lesion characteristics, diagnostic yield, complication rates and procedure duration of CBCT/fluoroscopic-guided and CT-guided techniques respectively.
Result & Outcome :
Since commencing our service, we have performed 277 CBCT/fluoroscopic-guided biopsies, accounting for 43.6% of all cases. There is an expansion in total capacity for image-guided lung biopsies by 96.8%, from 155 cases to 305 cases per year. The median waiting time has shortened from 44.0 days to 31.5 days, enabling earlier diagnosis and treatment initiation for lung cancer patients. The additional cases, if performed using CT-guided approach, would equate to an estimated 600 non-contrast CT slots annually. In addition, a subgroup analysis was performed on solid and part-solid lesions ≥1.5cm. Both the CBCT/fluoroscopy group (N=233) and CT group (N=219) achieved high diagnostic yield (97.0% for CBCT/fluoroscopy vs 97.7% for CT, p=0.63) with similar median procedure time (21.0 mins for both, p=0.64). Complication rates were low and similar between the two groups (pneumothorax requiring chest drain insertion; 3.9% vs 5.0%, p=0.55, and hemoptysis requiring intervention; 0% vs 1.4%, for CBCT/fluoroscopy and CT respectively). In conclusion, CBCT/fluoroscopic-guided lung biopsy is a highly effective alternative to conventional CT-guided biopsy with high diagnostic yield and low complication rates. Our new service has substantially increased our department’s capacity for image-guided lung biopsy without the need to encroach on CT scanner time. These improvements demonstrate the service’s role in optimizing resource utilization, meeting rising demand, and improving patient care.
