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Vascular and/or Interventional Radiology

E1200. Utility of Completion Imaging Prior to Lung Biopsy: Measure Twice, Cut Once

Furman M,  Makwana N,  Baird G,  Beland M,  Grand D. Alpert Medical School of Brown University, Providence, RI

Address correspondence to M. Furman (furman.m@gmail.com)

Objective: CT-guided lung biopsy is one of the most common percutaneous procedures performed in our department. Once malignancy is established, patients undergo completion imaging (PET/CT or contrast-enhanced CT of the chest, abdomen and pelvis) prior to treatment. We hypothesize that obtaining completion imaging prior to lung biopsy would identify safer biopsy targets, and allow for definitive staging.

Materials and Methods: This retrospective analysis was performed under institutional review board waiver and was HIPAA compliant. A full text search of radiology reports for two hospitals from January 2015 to December 2016 was conducted using a data-mining system (Montage, Montage Healthcare Systems). A keyword search term of “lung biopsy” with CPT code for needle biopsy procedure yielded an initial set of reports. Patients were included in this review if they underwent percutaneous lung biopsy prior to completion imaging and subsequently had completion imaging in our system, within 3 months.

Results: A total of 129 patients meeting our inclusion criteria were identified. Completion imaging subsequently identified an alternative site for biopsy in 40/129 (31%) of patients. Of these 40 patients, 18 (45%), or 14% of the total cohort, underwent a second biopsy to complete staging prior to therapy. There were no reported complications from additional biopsy.

Conclusion: Thirty-one percent of patients who underwent percutaneous lung biopsy in our cohort could have instead undergone a potentially safer procedure had they first undergone completion imaging. Fourteen percent of the total cohort could have avoided the need for a second biopsy to complete staging. Completion imaging should be performed prior to CT-guided lung biopsy to preferentially target sites outside the lung, which are safer to biopsy and provide definitive staging.