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Objective:
This exhibit aims to determine the incidence of pneumothorax as a complication of transthoracic lung mass biopsy using C-Arm cone beam computed tomography (CBCT) compared with traditional multidetector computed tomography (MDCT) guidance, and to evaluate for associations between image guidance modality, lesion characteristics, clinical risk factors, and biopsy-related complications, which can be used for future biopsy imaging modality risk stratification.

Materials and Methods:
At our community hospital-based interventional radiology practice, CBCT with needle guidance software was utilized during a three-month period of CT scanner down time. A retrospective study was performed, comparing complications during that period to a preceding six-month interval when MDCT was used. For the primary analysis, patients were grouped based on imaging modality (CBCT n=37; CT n=64). Additional analyses dividing patients based on lesion size, lesion pleural depth, bullous lung change, chest tube placement, history of COPD, and smoking history were also carried out to assess for related pneumothorax risk factors. A prospective randomized study (n = 100) is currently ongoing comparing the incidence of pneumothorax between CBCT and MDCT guided lung biopsy among patients considered low or normal risk for pneumothorax. In addition to the patient and lesion characteristics described above, other data points collected include radiation exposure, diagnostic sample yield, and procedure time.

Results:
The retrospective arm demonstrated that there was no increased incidence of pneumothorax when comparing CBCT (n = 37) to MDCT (n = 64). There was no significant association between biopsy imaging guidance modality and consequent pneumothorax (p = .69). However, a significant interaction was observed between chest tube placement and diagnosed COPD (p = .03). Additionally, all patients requiring chest tube placement were either current or former smokers. This association approached but did not reach statistical significance. The prospective portion of the study is currently ongoing. Preliminary data and proceduralist experience suggest that there is no increased risk of pneumothorax or suboptimal tissue yield between biopsy imaging guidance modalities.

Conclusion:
Our preliminary data show no increased risk of pneumothorax among patients undergoing CBCT-guided lung mass biopsy. These findings support previously reported studies at other institutions among experienced operators. This is significant, particularly in a community hospital practice, where resource allocation may be necessary more frequently, compared to larger tertiary care settings. With proper risk stratification we believe that CBCT is a viable alternative lung biopsy imaging guidance modality. CBCT with needle guidance is an additional tool that can allow interventional radiologists to deliver high quality and safe patient care.