Clinical potential of computed tomography-guided coaxial needle sequence puncture with suture-anchored needle guidance and coupled needle retraction-and-advancement technique biopsy of pulmonary nodules

Introduction Computed tomography (CT)-guided percutaneous pulmonary nodule biopsy is a technique for determining the nature of nodules. However, the puncture accuracy and biopsy success rate decline as pulmonary nodule diameter decreases. This study aimed to evaluate the clinical applicability of a CT-guided coaxial needle using suture-anchored needle guidance sequential puncture and coupled needle retraction-and-advancement technique biopsy modes for pulmonary nodules, compared with conventional pulmonary nodule synchronous puncture and coaxial needle insertion biopsy modes. In addition, pulmonary nodule puncture accuracy and biopsy success rates were evaluated. Methods A total of 158 patients with solitary pulmonary nodules were randomly assigned to two groups (79 patients per group). Group A underwent a sequential puncture mode of pulmonary nodules and coupled needle retraction-and-advancement technique biopsy, whereas Group B underwent a conventional synchronous puncture mode of pulmonary nodules and coaxial needle insertion biopsy (Group B). The first coaxial needle withdrawal rate, off-target rate, target periphery rate, target central rate, biopsy tissue strip length, first and final biopsy success rates of pulmonary nodules, and procedure-related complications were compared between the groups. Results The success rate of first-attempt biopsy in Group A was significantly higher than that in Group B (76/79 [96.2%] vs. 60/79 [75.9%], P = 0.002). The relative risk (RR) of first-attempt biopsy success in Group A vs. Group B was 1.27 (95% confidence interval [CI], 1.13–1.43%), and the absolute risk difference was 20.3% (95% CI, 8.7–31.9%). Needle withdrawal occurred in 4 patients (5.1%) in Group A, which was significantly lower than the 31 (39.2%) patients in Group B ( P < 0.001). The composition ratios of the three spatial positions of coaxial needle tips and pulmonary nodules differed significantly between the two groups ( P < 0.01). The ratio of sampling strip length to pulmonary nodule diameter × 100% on the first biopsy was significantly higher in Group A than in Group B (100 [50,100] vs. 40 [3,76], P < 0.001). Discussion CT-guided coaxial needle sequential puncture with suture-anchored needle guidance can enhance pulmonary nodule puncture accuracy, and the coupled needle retraction-and-advancement technique improves biopsy success rate. Clinical trial registration http://www.chictr.org.cn , identifier (ChiCTR2400088764).