Modern navigation techniques for transthoracic core needle biopsy

Abstract

Transthoracic core-needle biopsy is a minimally invasive and effective procedure for histological verification of intrathoracic lesions. It’s accuracy can be assisted by ultrasound or robotic navigation. Material and methods. Retrospective analysis of 45 transthoracic core-needle biopsies under ultrasound and robotic guidance. Results. The accuracy of both methods is over 90% and complications rate is comparable. Ultrasound guidance is more suitable for large subpleural lesions, attached to the chest wall. Robotic guidance allows more precise positioning for small lesions, but takes much more time. Complications rate for ultrasound-guidance was 5,3% vs 15,4% for robotic guidance. However, none of these complications required surgical intervention. Even 3 tissue samples provided enough material for immunostaining and for molecular analysis if necessary. Summary. Transthoracic core needle biopsy is a method of choice for histological verification of large solid intrathoracic lesions, adherent to the chest wall, without large cavities of destruction. Such patients have the lowest risk rate of possible complications and are suitable for multiple biopsies. At the same time, these patients do not fit for VATS due to large size of the tumor and pleural adhesions, which can be difficult to manage during thoracoscopy. Ultrasound guidance can be best of all applied for large solid tumors, invading the chest wall.