Clinical efficacy of 99mTc-MIBI SPECT/CT compared with CBCT in lung biopsies: a retrospective cohort study

Background This study aimed to evaluate the clinical value of 99m Tc-MIBI SPECT/CT (Single-Photon Emission Computed Tomography/Computed Tomography) imaging-guided percutaneous lung aspiration biopsy by comparing its diagnostic accuracy and complication rates to those of CBCT-guided biopsy. Methods A total of 115 patients who underwent percutaneous lung aspiration biopsy at Suining Central Hospital from September 2019 to December 2020 were included. Patients were assigned to either the 99m Tc-MIBI SPECT/CT-guided group (n = 34) or the CBCT-guided group (n = 81). Baseline characteristics, including age, sex, lesion location, type, and size, were statistically analyzed to ensure comparability. Bayesian multilevel logistic regression was utilized for subgroup analyses, and Clopper-Pearson exact intervals were calculated for accuracy metrics. Diagnostic accuracy and post-procedure complications were evaluated. In the SPECT/CT group, the target-to-background Ratio (TBR) uptake ratio was measured, and its predictive value for malignancy was assessed via ROC curve analysis. Interobserver reliability for TBR ratios was determined using the intraclass correlation coefficient (ICC). Results Baseline characteristics were comparable between groups (all p > 0.05). The SPECT/CT-guided group achieved 100% diagnostic accuracy, outperforming the CBCT-guided group (93.83%). Higher TBR ratios on SPECT/CT were strongly predictive of malignancy (AUC = 1.0, ICC = 0.938). For mass-type lesions 3–3.99 cm in diameter, SPECT/CT guidance yielded significantly higher accuracy than CBCT (p = 0.027, Posterior Probability of Superiority >96%). No significant accuracy differences were observed in other lesion locations, except for superior results in the left lower lobe with SPECT/CT. Complication rates were similar (23.53% vs. 16.05%, p > 0.05). Conclusion 99m Tc-MIBI SPECT/CT-guided biopsy serves as a promising exploratory tool for metabolic navigation in lung biopsies. It may offer incremental value in identifying viable tumor tissue within intermediate-sized masses without compromising safety. Given the pilot nature of this study, these findings are hypothesis-generating and necessitate confirmation through prospective, multicenter randomized trials.