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CT-Guided Transthoracic Needle Biopsy Using a Puncture Site-Down Positioning Technique

Fumiko Kinoshita1,2, Takashi Kato3, Kimihiko Sugiura1, Masamichi Nishimura4, Toshibumi Kinoshita1, Masayuki Hashimoto1, Toshio Kaminoh1 and Toshihide Ogawa1

1 Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, Tottori 683-8506, Japan.
2 Department of Radiology, Matsue National Hospital, Matsue, Shimane, Japan.
3 Kato Clinic, Yonago, Tottori, Japan.
4 Clinical Laboratory, Hamada Medical Center, Hamada, Shimane, Japan.


Figure 1
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  		Fig. 1A —Equipment for puncture site-down technique. Photograph shows supporting bed constructed for puncture site-down technique.

 

Figure 2
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  		Fig. 1B —Equipment for puncture site-down technique. Drawing shows supporting bed with patient in position for biopsy, Velcro straps, biopsy needle, and needle holder.

 

Figure 3
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  		Fig. 1C —Equipment for puncture site-down technique. Photograph shows 10 cm by 10 cm puncture window (PW) and biopsy needle in needle holder attached under puncture window, which slides horizontally in all directions and its angle can also be changed (arrows).

 

Figure 4
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  		Fig. 2A —74-year-old man with primary lung cancer. Transverse high-resolution CT scan obtained before biopsy with patient in spine position shows right upper lobe mass at depth of 3 cm from pleura surface.

 

Figure 5
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  		Fig. 2B —74-year-old man with primary lung cancer. CT scan obtained before biopsy with patient in right lateral decubitus position shows mass has shifted to puncture site and is at depth of 2 cm from pleura surface. Skin and subcutaneous tissue are fixed in puncture window due to patient's body weight.

 

Figure 6
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  		Fig. 2C —74-year-old man with primary lung cancer. Biopsy gun was advanced to margin of lesion and fired. Note that needle holder keeps automated cutting needle in place.

 

Figure 7
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  		Fig. 2D —74-year-old man with primary lung cancer. No pneumothorax was observed on CT scan obtained after biopsy. Minimal parenchymal bleeding after biopsy was visible surrounding needle track.

 

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