Trans-osseous coaxial biopsy for pulmonary lesions under CT guidance: Technical efficacy for challenging location.

Objective: To retrospectively analyze CT-guided percutaneous cutting biopsy approach of lung lesions via the trans-osseous approach. Methods: The data of 17 lesions in 16 patients who underwent consecutive CT-guided percutaneous trans-osseous coaxial cutting biopsy of lung lesions were retrospectively analyzed. The procedure involved creating an artificial bone channel using a bone puncture needle under CT guidance, through which the coaxial cutting biopsy was performed. We assessed technical success rate, complications and pathological diagnosis accuracy. Results: 17 lesions across 16 patients were biopsied using the CT-guided percutaneous trans-osseous coaxial cutting technique. The scapular approach was used for 13 lesions in the posterior upper lung lobe, while the sternal approach was employed for 4 lesions in the anterior upper lung lobe near the heart and major vessels. The technical success rate was 94%, yielding a positive pathological diagnosis rate of 100%. The incidence of pneumothorax was 12.5%, and all of them required intervention. No other complications were reported in the remaining patients. Conclusion: CT-guided percutaneous trans-osseous coaxial cutting biopsy technique is a valuable and viable alternative technique, particularly for lung lesions in challenging locations, such as the posterior segment and anterior upper lobe adjacent to the heart and major vessel. This approach may reduce the risk of complications such as pneumothorax and hemoptysis, making it a valuable option for difficult-to-access lung lesions.