Retrospective Evaluation of Safety of Using a Semi-automatic Robotic System for Transthoracic Biopsy of Lung Mass Under Positron Emission Tomography-computed Tomography Guidance.
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Abstract
Objective: Lung cancer poses unique challenges due to heterogeneity in tumor and metastatic cellular composition. The use of 18F-fluorodeoxy glucose positron emission tomography-computed tomography (18F-FDG PET-CT) integrates functional and anatomical imaging. This study assessed the safety and diagnostic yield of PET-CT-guided transthoracic needle biopsy for intrathoracic mass lesions using a semi-automatic robotic system.
Material and methods: Forty consecutive patients underwent whole-body PET-CT imaging following which they underwent transthoracic biopsy, using a semi-automatic robotic biopsy system (MaxioTM III; Perfint Healthcare Pvt Ltd., Chennai, Tamil Nadu, India), consisting of docking system, digital screen and a stereotactic arm. Clinicodemographic profile, PET-CT and biopsy findings, histopathology reports, and complications were retrieved from patient records.
Results: The mean age of the patients was 57.08±12.39 years, and the mean maximum standardized uptake value was 16.71±8.61. PET-CT revealed a unilateral lung mass in 92.5% (n = 37) and bilateral lesions in 7.5% (n = 3) of patients. Heterogeneous 18F-FDG uptake was noted in 97.5% (n = 39). The average target lesion distance was 40±12.7 mm. At least four biopsy cores were obtained in all patients except one. Core length was 2 cm in 90% of cases. The most common complication was local pain, followed by pneumothorax in 12.5% (n = 5). Tissue was adequate for analysis in all cases. None of the patients had to undergo repeat PET-CT or biopsy. The diagnostic yield was 100%, with malignancy in 82.5% (n = 33), acute inflammation in 10% (n = 4), and tuberculosis in 7.5% (n = 3). 50% (n = 20) underwent next-generation sequencing for targeted mutation testing.
Conclusion: Semiautomatic robotic assistance can be a safe option for diagnosing intrathoracic mass lesions, with an acceptable diagnostic yield.
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