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Computed tomography-guided lung biopsy: a randomized controlled trial of low-dose versus standard-dose protocol.

Abstract：

OBJECTIVES:To assess the relative diagnostic utility of low- and standard-dose computed tomography (CT)-guided lung biopsy. METHODS:In this single-center, single-blind, prospective, randomized controlled trial, patients were enrolled between November 2016 and June 2017. Enrolled study participants were randomly selected to undergo either low- or standard-dose CT-guided lung biopsy. Diagnostic accuracy was the primary study endpoint, whereas technical success, radiation dose, and associated complications were secondary study endpoints. RESULTS:In total, 280 patients underwent study enrollment and randomization, with 271 (low-dose group, 135; standard-dose group, 136) receiving the assigned interventions. Both groups had a 100% technical success rate for CT-guided lung biopsy, and complication rates were similar between groups (p > 0.05). The mean dose-length product (36.0 ± 14.1 mGy cm vs. 361.8 ± 108.0 mGy cm, p < 0.001) and effective dose (0.5 ± 0.2 mSv vs. 5.1 ± 1.5 mSv, p < 0.001) were significantly reduced in the low-dose group participants. Sensitivity, specificity, and overall diagnostic accuracy rates in the low-dose group were 91.8%, 100%, and 94.6%, respectively, whereas in the standard-dose group, the corresponding values were 89.6%, 100%, and 92.4%, respectively. These results indicated that diagnostic performance did not differ significantly between the 2 groups. Using univariate and multivariate analyses, we found larger lesion size (p = 0.038) and procedure-related pneumothorax (p = 0.033) to both be independent predictors of diagnostic failure. CONCLUSIONS:Our results demonstrate that low-dose CT-guided lung biopsy can yield comparable diagnostic accuracy to standard-dose CT guidance, while significantly reducing the radiation dose delivered to patients. TRIAL REGISTRATION:ClinicalTrials.gov NCT02971176 KEY POINTS: • Low-dose CT-guided lung biopsy is a safe and simple method for diagnosis of lung lesions. • Low-dose CT-guided lung biopsy can yield comparable diagnostic accuracy to standard-dose CT guidance. • Low-dose CT-guided lung biopsy can achieve a 90% reduction in radiation exposure when compared with standard-dose CT guidance.

journal_name

Eur Radiol

journal_title

European radiology

authors

Fu YF,Li GC,Xu QS,Shi YB,Wang C,Wang T

doi

10.1007/s00330-019-06464-6

subject

Has Abstract

pub_date

2020-03-01 00:00:00

pages

1584-1592

issue

eissn

0938-7994

issn

1432-1084

pii

10.1007/s00330-019-06464-6

journal_volume

pub_type

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Computed tomography-guided lung biopsy: a randomized controlled trial of low-dose versus standard-dose protocol.