A Comparative Study of Computed Tomography-Guided Steerable Needle and Freehand Biopsy for Diagnosing Small Pulmonary Nodules: Accuracy and Complications for Greater Clarity and Precision

Introduction This study aimed to retrospectively evaluate and compare the accuracy, complication rate, and feasibility of computed tomography (CT)-guided introducer-assisted percutaneous lung biopsy with those of freehand percutaneous lung biopsy for the diagnosis of pulmonary nodules ≤ 2 cm. Methods We retrospectively analysed clinical data of 307 patients with pulmonary nodules ≤ 2 cm who underwent percutaneous lung biopsy between January 2015 and August 2024. The patients were divided into two groups: A, 153 patients undergoing freehand puncture, and B, 154 patients in whom the procedure was assisted by a guidance device. A statistical analysis was performed to assess the success rate, diagnostic accuracy, and complication rate of the two techniques and to evaluate the feasibility of using a guide device-assisted puncture biopsy for small pulmonary nodules. Results All 307 patients successfully completed the percutaneous biopsy procedure (100% technical success rate). Diagnostic accuracy was 95.4% and 96.8% in Groups A and B, respectively ( p = .161). Groups A and B required an average of 9.04 ± 2.58 and 8.14 ± 1.72 intraoperative CT scans, respectively ( p < .001). Mean procedural durations for Groups A and B were 12.77 ± 4.51 and 10.83 ± 2.51 min, respectively ( p < .001). In Groups A and B, the immediate need for closed thoracic drainage was 4.6% (7/153) and 1.9% (3/154), respectively ( p = .165), and incidence of haemoptysis was 10.5% (16/153) and 9.7% (15/154), respectively ( p = .492). Neither group experienced complications such as air embolism or needle tract seeding metastasis. Conclusion Both CT-guided needle biopsy performed using a guidance device and freehand biopsy demonstrated high diagnostic accuracy for pulmonary nodules ≤ 2 cm. Procedures conducted with a guidance device contributed to shorter operation times, fewer CT scans, and lower radiation exposure.