CT-guided biopsy of lung lesions using two needles in difficult and poorly cooperative patients

The purpose of our study was to evaluate the feasibility and safety of CT-guided percutaneous lung biopsy using two needles in difficult and poorly cooperative patients; and to examine the usefulness of the malpositioned first needle in tissue sampling with a second needle. This study included 17 consecutive patients with unsuccessful first insertion of the biopsy needle in the normal lung parenchyma and re-attempted tissue sampling through another puncture site using a second needle with the first needle retained in position until completion of the biopsy. We examined the difficult factors in biopsy that led to a failed first attempt, success rate of tissue sampling, procedure-related complications, and usefulness of the malpositioned needle. There were 1 or multiple difficult factors in all patients. In all 17 patients, core samples were successfully obtained using a second needle. Post-procedure pneumothorax and parenchymal hemorrhage occurred in 4 and 3 patients, respectively. The first needle was used as a navigational reference point for lesion localization in all patients and as an anchor restricting the mobility of the lung in patients with pneumothorax or poor breath holding capacity. CT-guided needle biopsy of the lung using a second needle without removing the first malpositioned needle is feasible and safe. During biopsy procedures in difficult or poorly cooperative patients, the malpositioned needle provides a navigational reference point or serves as an anchor to hold the movable lung.