CT-guided PTCB is essential for the differential diagnosis between benign and malignant pulmonary and mediastinal tumors and for cellular characterization by somatic mutation and cellular differentiation analysis.
Cellular characterization is becoming more and more important due to the development of oncologic targeted therapies and will be a field of growing interest in the near future[1-2]. For the same reasons,
coaxial core biopsies are currently preferred to cytological specimens,
Methods and materials
For the present study a MyLabTwice ultrasound scanner equipped with an EM tracking system and Virtual Navigation (VN) software (ESAOTE,
Italy) and a 64 MDCT (Aquilion,
Japan) were used.
The procedure was performed with a convex transducer with single use multi-angle (15°-30°-45°) guiding system and reusable tracking bracket for magnetic sensor (CIVCO,
USA) (Fig 1).
Spatial coregistration was obtained with a reference device (omniTRAX) with a dedicated additional magnetic sensor (Fig...
Preliminary tests with the Styrofoam phantom demonstrated no influence from the ferromagnetic environment if the volume of interest was at least 1meter away from the CT gantry.
In this setting the coregistration was accurate and immediate (Fig 9). 35 samples were obtained on the 15 lesions (maximum diameter ranging from 40 to 15 mm.; average 25) in 15 patients (age 45-85,
with an average of 72).
In all cases,
a single step procedure was possible without the necessity of needle repositioning....
Our preliminary study demonstrates that PVNG transthoracic lung biopsies are feasible as the ferromagnetic environment of the CT unit does not significantly affect the accuracy of the EM tracking device according to the experience of Wood et al .
A test with a phantom is however mandatory,
as the results can be related to the specific CT unit used.
The use of a small reference device (i.e.
omniTRAX) allows a small Z-Axis CT scan to be performed during the planning phase,
1] I-Chen Tsai,
Si-Wa Chan and Clayton Chi-Chang Chen.
CT-Guided Core Biopsy of Lung Lesions: A Primer.
AJR 2009;193: 1228-1235. 2] Paez JG,
EGFR mutations in lung cancer: correlation with clinical response to gefitinib therapy.
2004 Jun 4;304(5676):1497-500. 3]...