{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T19:52:31Z","timestamp":1784663551491,"version":"3.55.0"},"reference-count":30,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,1,10]],"date-time":"2026-01-10T00:00:00Z","timestamp":1768003200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Percutaneous transthoracic needle biopsy (PTNB) using advanced navigation techniques is increasingly performed; however, pulmonologists\u2019 experience remains limited. This study reports an interventional pulmonologist\u2019s initial experience with cone-beam computed tomography (CBCT) laser-guided PTNB and the diagnostic performance for lesions with diameters greater than or less than 20 mm. Methods: We retrospectively analysed the data of patients who underwent PTNB in a C-arm CBCT-equipped hybrid operating room between July 2020 and March 2024. All patients underwent the biopsy procedure under local anaesthesia. This was preceded by an initial 3D scan for planning of the needle route, followed by coaxial needle insertion. A post-procedural scan was also performed to identify complications. Results: Seventy-seven patients were enrolled in the study. The median distances of the needle path from the skin to the pleura and from the pleura to the lesion were 33.4 mm and 31.7 mm, respectively. The median number of tissue samplings was 4.9 \u00b1 1.8. The median operating room duration was 51.5 \u00b1 25.7 min, respectively. The median total dose area product was 8485.4 \u00b1 5819.9 \u00b5Gym2. The sensitivity and specificity of our study findings were 93.3% (56\/60) and 100%, while the accuracy was 94.8% (73\/77). The overall complication rate was 13%. Conclusions: PTNB procedure by pulmonologists is a feasible and safe, single-operator workflow in a hybrid operating room. It can be performed under CBCT laser guidance with a similar diagnostic yield, acceptable radiation exposure and procedure duration, and minimal or manageable complications.<\/jats:p>","DOI":"10.3390\/diagnostics16020226","type":"journal-article","created":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T07:30:34Z","timestamp":1768203034000},"page":"226","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Cone-Beam Computed Tomography Laser-Guided Transthoracic Needle Biopsy for Pulmonary Lesions in a Hybrid Operating Room: Feasibility Study by an Interventional Pulmonologist"],"prefix":"10.3390","volume":"16","author":[{"given":"Lun-Che","family":"Chen","sequence":"first","affiliation":[{"name":"Interventional Pulmonology Centre, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu 300195, Taiwan"},{"name":"Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu 300195, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Po-Keng","family":"Su","sequence":"additional","affiliation":[{"name":"Interventional Pulmonology Centre, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu 300195, Taiwan"},{"name":"Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu 300195, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geng-Ning","family":"Hu","sequence":"additional","affiliation":[{"name":"Interventional Pulmonology Centre, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu 300195, Taiwan"},{"name":"Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu 300195, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shwetambara","family":"Malwade","sequence":"additional","affiliation":[{"name":"Department of Advanced Therapies, Siemens Healthcare Limited, Taipei City 11503, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen-Yuan","family":"Chung","sequence":"additional","affiliation":[{"name":"Interventional Pulmonology Centre, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu 300195, Taiwan"},{"name":"Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu 300195, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ling-Kai","family":"Chang","sequence":"additional","affiliation":[{"name":"Interventional Pulmonology Centre, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu 300195, Taiwan"},{"name":"Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu 300195, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6129-627X","authenticated-orcid":false,"given":"Shun-Mao","family":"Yang","sequence":"additional","affiliation":[{"name":"Interventional Pulmonology Centre, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu 300195, Taiwan"},{"name":"Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu 300195, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1612","DOI":"10.1378\/chest.09-0370","article-title":"CT fluoroscopy-guided biopsy of 1000 pulmonary lesions performed with 20-gauge coaxial cutting needles: Diagnostic yield and risk factors for diagnostic failure","volume":"136","author":"Hiraki","year":"2009","journal-title":"Chest"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1148\/radiol.13131265","article-title":"C-arm cone-beam CT-guided percutaneous transthoracic needle biopsy of lung nodules: Clinical experience in 1108 patients","volume":"271","author":"Lee","year":"2014","journal-title":"Radiology"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1665","DOI":"10.2214\/ajr.180.6.1801665","article-title":"CT-guided transthoracic needle aspiration biopsy of small (\u226420 mm) solitary pulmonary nodules","volume":"180","author":"Ohno","year":"2003","journal-title":"Am. J. Roentgenol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e93S","DOI":"10.1378\/chest.12-2351","article-title":"Evaluation of individuals with pulmonary nodules: When is it lung cancer? Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines","volume":"143","author":"Gould","year":"2013","journal-title":"Chest"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1007\/s00270-019-02163-3","article-title":"Virtual guidance of percutaneous transthoracic needle biopsy with C-arm cone-beam CT: Diagnostic accuracy, risk factors and effective radiation dose","volume":"42","author":"Fior","year":"2019","journal-title":"Cardiovasc. Intervent Radiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"S1047","DOI":"10.21037\/jtd.2017.05.48","article-title":"Bronchoscopy for the diagnosis of peripheral lung lesions","volume":"9","author":"Dhillon","year":"2017","journal-title":"J. Thorac. Dis."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Ahn, J.H., and Jang, J.G. (2019). Initial experience in CT-guided percutaneous transthoracic needle biopsy of lung lesions performed by a pulmonologist. J. Clin. Med., 8.","DOI":"10.3390\/jcm8060821"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Gulias-Soidan, D., Crus-Sanchez, N.M., Fraga-Manteiga, D., Cao-Gonz\u00e1lez, J.I., Balboa-Barreiro, V., and Gonz\u00e1lez-Mart\u00edn, C. (2020). Cone-beam CT-guided lung biopsies: Results in 94 patients. Diagnostics, 10.","DOI":"10.3390\/diagnostics10121068"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1007\/s00330-016-4357-8","article-title":"Complication rates of CT-guided transthoracic lung biopsy: Meta-analysis","volume":"27","author":"Heerink","year":"2017","journal-title":"Eur. Radiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"S17","DOI":"10.4046\/trd.2020.0156","article-title":"Transthoracic needle biopsy: How to maximize diagnostic accuracy and minimize complications","volume":"83","author":"Chung","year":"2020","journal-title":"Tuberc. Respir. Dis."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1159\/000080638","article-title":"Safety and yield of ultrasound-assisted transthoracic biopsy performed by pulmonologists","volume":"71","author":"Diacon","year":"2004","journal-title":"Respiration"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1097\/LBR.0000000000000297","article-title":"Ultrasound-guided lung biopsy in the hands of respiratory physicians: Diagnostic yield and complications in 215 consecutive patients in 3 centers","volume":"23","author":"Laursen","year":"2016","journal-title":"J. Bronchol. Interv. Pulmonol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1016\/j.arbr.2016.03.004","article-title":"Benefit of chest ultrasonography in the diagnosis of peripheral thoracic lesions in an interventional pulmonology unit","volume":"52","author":"Fabregat","year":"2016","journal-title":"Arch. Bronconeumol."},{"key":"ref_14","first-page":"204","article-title":"Ultrasound-guided percutaneous needle aspiration by pulmonologists: A study of factors with impact on procedural yield and complications","volume":"22","author":"Meena","year":"2015","journal-title":"J. Bronchol. Interv. Pulmonol."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Yang, L., Wang, Y., Li, L., Liu, D., Wu, X., Zhang, W., Pan, F., Liang, H., and Zheng, C. (2022). C-arm cone-beam CT virtual navigation versus conventional CT guidance in the transthoracic lung biopsy: A case-control study. Diagnostics, 12.","DOI":"10.3390\/diagnostics12010115"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1186\/s40644-019-0240-6","article-title":"Accuracy and complications of CT-guided pulmonary core biopsy in small nodules: A single-center experience","volume":"19","author":"Huang","year":"2019","journal-title":"Cancer Imaging"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2108","DOI":"10.1007\/s00330-010-1783-x","article-title":"Initial experience of percutaneous transthoracic needle biopsy of lung nodules using C-arm cone-beam CT systems","volume":"20","author":"Jin","year":"2010","journal-title":"Eur. Radiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1342","DOI":"10.1016\/j.jvir.2016.05.034","article-title":"Prospective randomized trial for image-guided biopsy using cone-beam CT navigation compared with conventional CT","volume":"27","author":"Fisher","year":"2016","journal-title":"J. Vasc. Interv. Radiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1007\/s11547-015-0604-3","article-title":"Flat detector C-arm CT-guided transthoracic needle biopsy of small (\u22642.0 cm) pulmonary nodules: Diagnostic accuracy and complication in 100 patients","volume":"121","author":"Jiao","year":"2016","journal-title":"Radiol. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"470","DOI":"10.5152\/dir.2014.13463","article-title":"Clinical applications of the C-arm cone-beam CT-based 3D needle guidance system in performing percutaneous transthoracic needle biopsy of pulmonary lesions","volume":"20","author":"Jiao","year":"2014","journal-title":"Diagn. Interv. Radiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2767","DOI":"10.1007\/s00330-007-0651-9","article-title":"Flat-detector computed tomography (FD-CT)","volume":"17","author":"Kalender","year":"2007","journal-title":"Eur. Radiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"S523","DOI":"10.1016\/j.jvir.2009.04.059","article-title":"Three-dimensional C-arm cone-beam CT: Applications in the interventional suite","volume":"20","author":"Wallace","year":"2009","journal-title":"J. Vasc. Interv. Radiol."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Chen, L.C., Yang, S.M., Malwade, S., Chang, H.C., Chang, L.K., Chung, W.Y., Ko, J.-C., and Yu, C.-J. (2023). Cone-beam computed-tomography-derived augmented fluoroscopy-guided biopsy for peripheral pulmonary nodules in a hybrid operating room: A case series. Diagnostics, 13.","DOI":"10.3390\/diagnostics13061055"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"3309","DOI":"10.1007\/s00330-023-10360-5","article-title":"Cone-beam computed tomography image-guided percutaneous microwave ablation for lung nodules in a hybrid operating room: An initial experience","volume":"34","author":"Chang","year":"2024","journal-title":"Eur. Radiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"92","DOI":"10.2214\/AJR.22.28712","article-title":"Cone-beam CT with enhanced needle guidance and augmented fluoroscopy overlay: Applications in interventional radiology","volume":"221","author":"Key","year":"2023","journal-title":"Am. J. Roentgenol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"330","DOI":"10.4046\/trd.2017.0123","article-title":"CT-guided percutaneous transthoracic needle biopsy using the additional laser guidance system by a pulmonologist with 2 years of experience in CT-guided percutaneous transthoracic needle biopsy","volume":"81","author":"Jeon","year":"2018","journal-title":"Tuberc. Respir. Dis."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1016\/j.tranon.2015.04.006","article-title":"Percutaneous Transthoracic Lung Biopsy: Comparison Between C-Arm Cone-Beam CT and Conventional CT Guidance","volume":"8","author":"Cheng","year":"2015","journal-title":"Transl. Oncol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"W400","DOI":"10.2214\/AJR.09.3963","article-title":"C-arm cone-beam CT-guided percutaneous transthoracic lung biopsy: Usefulness in evaluation of small pulmonary nodules","volume":"195","author":"Hwang","year":"2010","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1007\/s00330-012-2644-6","article-title":"Percutaneous transthoracic needle biopsy of small (1 cm) lung nodules under C-arm cone-beam CT virtual navigation guidance","volume":"23","author":"Choo","year":"2013","journal-title":"Eur. Radiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1007\/s00330-015-3861-6","article-title":"Comparison of cone-beam CT-guided and CT fluoroscopy-guided transthoracic needle biopsy of lung nodules","volume":"26","author":"Rotolo","year":"2016","journal-title":"Eur. Radiol."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/2\/226\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T07:41:21Z","timestamp":1768203681000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/2\/226"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,10]]},"references-count":30,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["diagnostics16020226"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16020226","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,10]]}}}