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CT-Guided Transthoracic Needle Biopsy Using an Ipsilateral Dependent Position

¹ Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, 111 E. 210th St., Bronx, NY 10467-2490.
² Department of Radiology, New York Medical College and Westchester Medical Center, Valhalla, NY 10595.

OBJECTIVE. We postulated that the pneumothorax rate of transthoracic needle biopsy might improve with an ipsilateral dependent position of the affected side. We tried to determine the feasibility, effectiveness, and safety of CT-guided biopsy with the patient in this position.

SUBJECTS AND METHODS. CT-guided needle biopsy with the patient in an ipsilateral dependent position was performed in 23 patients with 17 lung lesions (15 posterior and two anterior) and six mediastinal lesions. Fine-needle aspiration was used in all patients, and core biopsy was also used in six patients. The technical difficulty of the procedure was classified into three grades compared with a routine transthoracic needle biopsy as follows: grade I, no more difficult; grade II, somewhat more difficult; and grade III, much more difficult.

RESULTS. Adequate samples were obtained in 22 (96%) of 23 patients. A small asymptomatic pneumothorax occurred in two patients (8.7%). Difficulty was rated grades I, II, and III in 18 (78%), two (9%), and three (13%) procedures, respectively. Four of the five grades II and III procedures were biopsies of anterior lesions. Traversing the pleura was avoided in three of six mediastinal masses.

CONCLUSION. Transthoracic needle biopsy of selected lung and mediastinal lesions using a ipsilateral dependent position is feasible, effective, and safe. The role of this technique for reducing the rate of pneumothorax as a result of the biopsy requires further investigation.

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