Computed tomography-guided biopsy for pulmonary nodules: comparison between with and without coaxial technique

The coaxial technique has been introduced as an auxiliary approach to computed tomography (CT)-guided pulmonary nodule (PN) biopsy to facilitate the acquisition of additional tissue samples. Here, the diagnostic efficacy and safety of CT-guided PN biopsy performed with and without the coaxial technique was investigated. Consecutive PN cases that had undergone CT-guided biopsy between January 2022 and December 2023, were retrospectively recruited and categorized into coaxial and non-coaxial biopsy groups. Biopsy-related parameters, diagnostic performance, and complication incidence were analyzed to compare outcomes between the groups. Overall, 299 patients underwent CT-guided biopsy for PNs, with one nodule biopsied in each patient. Among them, 147 patients underwent biopsy with the coaxial technique, while 152 underwent biopsy without it. Relative to the non-coaxial group, the coaxial group required significantly fewer needle punctures (1.3 ± 0.6 vs. 1.8 ± 0.6, P < 0.001), yielded more tissue specimens (3.0 ± 0.7 vs. 1.6 ± 0.7, P < 0.001), and had a shorter procedure duration (9.0 ± 2.6 vs. 15.7 ± 4.5 min, P < 0.001). The two groups exhibited comparable sensitivity (98.2% vs. 94.3%, P = 0.156), diagnostic accuracy (98.6% vs. 96.1%, P = 0.283), and diagnostic yield (80.3% vs. 75.0%, P = 0.247). However, the rate of adequate tissue acquisition for molecular testing at the initial biopsy was markedly higher in the coaxial group than in the non-coaxial group (97.8% vs. 86.2%, P = 0.004). The incidence rates of pneumothorax (11.2% vs. 16.3%, P = 0.196) and pulmonary hemorrhage (29.6% vs. 33.3%, P = 0.488) were comparable between the two groups. The coaxial technique effectively reduces procedural duration and significantly improves the rate of adequate tissue sample collection for molecular testing during CT-guided PN biopsy without increasing complication rates.