Discussion
lung hemorrhage, high-grade hemorrhage, pneumothorax
LUNG HEMORRHAGE, PNEUMOTHORAX, COMPLICATIONS
This RCT assessed the feasibility, safety, and diagnostic ability between low- and standard-dose CT-guided biopsy in PNs. Although the quality of images under the standard-dose CT was significantly better, low-dose CT resulted in similar technical success rates, the number of needle pathways, and the duration of procedures compared to standard-dose CT. Furthermore, unlike the conventional diagnostic images, the images for biopsy procedures do not require meticulous details of the lesion, but adequately observable locations of the needle tip and lesion are needed [Diagnostic yield usually indicates the ability to make a definite diagnosis by biopsy [Diagnostic accuracy was the primary endpoint for this RCT. The low-dose group's sensitivity and diagnostic accuracy rates were comparable to the standard-dose group. This finding was similar to that in previous studies which compared the effectiveness of low-dose and standard-dose CT-guided lung biopsy [Biopsy-related complications were also the important endpoints in this RCT. The comparative results of pneumothorax and lung hemorrhage indicated that the low-dose protocol did not decrease the safety of biopsy. Furthermore, the chest tube requirement rates were only 4% and 3% in low-dose and standard-group. Risk factors for pneumothorax and high-grade hemorrhage included a greater number of needle pathways, smaller lesion size, and lesion-pleura distance ≥ 30 mm. These risk factors were consistent with past investigations regarding CT-guided lung biopsy [The low-dose CT protocol could be achieved by reducing the tube voltage and/or current [This study had some limitations. First, we only used the block randomization method, but the randomization was not performed by the stratification of the lesion size. Therefore, the unbalanced data of lesion size was observed, which may cause selective bias. However, this study included PNs only. The difference in mean lesion size between the two groups was not large (24.8 mm vs. 23.5 mm). These findings may reduce the risk of bias. Second, this investigation did not find the risk factor of diagnostic failure. This finding could be due to the limited sample size. Third, we did not collected the CTDI