# Active breathing coordinator combines with custom-designed puncture needle improves diagnostic accuracy of ≤20 mm pulmonary nodules under CT-guidance: a real world prospective study

## TL;DR

A new method combining breathing control and a custom needle improves lung nodule biopsies for small tumors.

## Contribution

Combining an active breathing coordinator and custom puncture needle improves diagnostic accuracy for small pulmonary nodules.

## Key findings

- ABC-NG PTNB improved diagnostic accuracy and reduced errors compared to conventional CT-guided PTNB.
- Fewer punctures, CT scans, and radiation doses were observed in the ABC-NG PTNB group.
- Diagnostic accuracy was enhanced for non-zero angle punctures and lower lobe nodules.

## Abstract

CT-guided percutaneous transthoracic needle biopsy (PTNB) is still the main way for obtaining pathological diagnoses of pulmonary nodules. However, the small size and respiratory-induced motion reduce diagnostic accuracy for patients with small pulmonary nodules (≤20mm). In this study, we aimed to improve biopsy precision and diagnostic accuracy for patients with small pulmonary nodules via introducing significant refinements.

122 patients with ≤20mm pulmonary nodules were enrolled and randomly assigned to the ABC-NG PTNB group and CT-guided PTNB group. The CT-guided PTNB group underwent conventional CT-guided PTNB, while the ABC-NG PTNB group received additional ways including thermoplastic immobilization, active breathing coordinator (ABC), and a custom-designed puncture needle. Puncture accuracy, diagnostic accuracy, and complication rates were compared between the two groups.

The ABC-NG PTNB group was superior to the CT-guided PTNB group in the terms of angle error, craniocaudal plane error, positioning error, diagnostic accuracy, and one-puncture success rate (P < 0.05). The ABC-NG PTNB group had fewer punctures, fewer CT scans, lower radiation doses, and lower incidence of pneumothorax as compared to CT-guided PTNB group (P < 0.05). Furthermore, diagnostic accuracy was particularly enhanced in cases where the puncture angle was non-zero or when the nodules were located in the lower lung lobes (P < 0.05).

Ct-guided PTNB combined with ABC and custom-designed puncture needle guide improves the accuracy and diagnosis rate of ≤20mm pulmonary nodule biopsy, especially nodules are located in the lower lung lobe or require a non-zero puncture angle.

ABC-NG PTNB was superior to CT-guided PTNB for patients with ≤ 20mm pulmonary nodules.

Active breathing coordinator combined with homemade puncture needle improves diagnostic accuracy for pulmonary nodules under CT guidance. The illustration compares CT-guided PTNB, showing sad lungs, with ABC-NG PTNB, showing happy lungs. ABC-NG PTNB is superior in terms of accuracy, success rate, fewer punctures, CT scans, and radiation doses, with a lower incidence of pneumothorax.