Effect of the respiratory motion of pulmonary nodules on CT-guided percutaneous transthoracic needle biopsy

Background Computed tomography (CT)-guided percutaneous transthoracic needle biopsy (PTNB) is highly affected by respiratory motion; however, respiratory motion of target nodule during the PTNB and its effect on CT-guided lung biopsy have not been studied. Purpose To investigate the effect of the respiratory motion of pulmonary nodules on CT-guided PTNB. Material and Methods We retrospectively reviewed the procedural CT scans of 426 pulmonary nodules that underwent PTNB during quiet breathing. Maximal and average respiratory motions were measured using the difference of table position of the targeted nodule between multiple procedural scans. Diagnostic performance, complications, and technical factors of PTNB in nodules with large motion (maximal motion >1 cm) were compared with those in nodules with small motion (≤1 cm). Results The mean maximal and average respiratory motions between tidal volume breathing were 5.4 ± 4.4 and 2.7 ± 2.6 mm, respectively. Sensitivity and accuracy were 93.1% and 96.1% in nodules with large motion, compared with 94.7% and 95.9% in nodules with small motion, respectively. Respiratory targeting ( P < 0.001), needle modulation ( P < 0.001), motion artifact of target ( P < 0.001), target disappearance from scans ( P < 0.001), and number of performed CT scans ( P < 0.001) were significantly higher in the large motion group, with no significant difference in radiation dose and complications between the groups. Conclusion The respiratory motion of pulmonary nodules during CT-guided PTNB may cause technical difficulties but does not affect diagnostic performance nor complications associated with PTNB.