Six Core Application Scenarios And Detailed Indications Of The Chiba Needle in Interventional Radiology

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The Chiba needle, also known as a Chiba biopsy needle or Chiba fine-needle aspiration needle, originated from Chiba University in Japan and is one of the most classic fine-needle aspiration (FNA) and percutaneous puncture instruments in interventional radiology. Its typical specifications are 20G–23G, with an outer diameter of approximately 0.7–0.9 mm and lengths mostly 15–20 cm. The needle tip bevel angle is approximately 25°–30°. With its thin wall, flexibility, and ability to bend moderately, it can follow complex paths under image guidance to reach deep-seated lesions. Because of its minimal tissue damage and low complication rate, the Chiba needle has become the "entry-level" gold-standard tool for percutaneous diagnosis and treatment under imaging guidance (ultrasound, CT, fluoroscopy, and occasionally MRI).

1. Percutaneous Fine Needle Aspiration Biopsy (FNA) - The Most Classic Use

The primary application of the Chiba needle is cytological biopsy of indeterminate space-occupying lesions in various locations. Under real-time ultrasound or CT guidance, a 21G or 22G Chiba needle is inserted into the tumor parenchyma, and a 5–10 mL syringe is attached to apply moderate negative pressure (usually 2–5 mL). The needle is moved back and forth or rotated in small amplitudes within the lesion to aspirate exfoliated cells into the needle lumen and syringe hub, and smears are prepared for pathological cytological examination. It is suitable for: pulmonary nodules, liver masses, pancreatic tumors, kidney tumors, thyroid nodules, breast lumps, lymph nodes, retroperitoneal and pelvic masses, etc. Literature reports that the cytological positivity rate of CT-guided Chiba needle lung biopsy can reach over 85%, with a malignant lesion detection accuracy of approximately 90%.

2. Cyst and Abscess Fluid Aspiration and Sclerotherapy

For hepatic cysts, renal cysts, ovarian cysts,以及各种 encapsulated effusions or abscesses, the Chiba needle can be used for diagnostic aspiration to determine characteristics (culture, biochemistry), or after evacuating cystic fluid, sclerosing agents (such as absolute ethanol or lauromacrogol) can be injected for interventional therapy. The fine needle reduces the risk of cystic fluid leakage and bleeding, and is especially suitable for lesions adjacent to important blood vessels.

3. Percutaneous Transhepatic Cholangiography (PTC) and Preoperative Localization for PTCD

In patients with obstructive jaundice, a 21G–22G Chiba needle is used to percutaneously and transhepatically puncture dilated intrahepatic bile ducts. After bile is aspirated, diluted iodine contrast agent is injected for PTC, clearly displaying the biliary tree, the obstruction plane, and the extent, providing a "roadmap" for subsequent percutaneous transhepatic biliary drainage (PTCD/PTBD). Compared with thicker needles, the Chiba needle significantly reduces the risk of biliary bleeding and bile leakage.

4. Establishing Micro-Channels and Guidewire Introduction (Initial Puncture)

In PTCD, percutaneous nephrostomy (PCN), or central venous micropuncture systems, the Chiba needle can serve as the first-step micropuncture needle - after puncturing the target structure (bile duct/renal pelvis/vein), the stylet is withdrawn, and a 0.018-inch microwire is introduced through the needle lumen, followed by exchange dilation to complete subsequent operations. This "micropuncture technique" greatly reduces bleeding and adjacent organ injury associated with large-caliber puncture.

5. Local Injection of Drugs or Contrast Agents

The Chiba needle can be used for intratumoral chemotherapy drug injection (such as initial localization puncture for alcohol/lipiodol injection in liver cancer), contrast agent/drug injection into joint cavities or for nerve blocks. Due to its fine diameter and low pain, patient tolerance is good.

6. Special Sites and Minimally Invasive Sampling in Pediatric/Elderly Patients

Because the Chiba needle causes minimal trauma (puncture tract only about 0.7 mm), it is particularly suitable for cases with borderline abnormal coagulation function, the elderly, patients in poor general condition, or lesions closely adjacent to large blood vessels/capsules. It is also an important option for minimally invasive sampling of pediatric solid tumors.

Contraindications and cautions include: uncorrectable coagulation disorders (INR >1.5, PLT <50×10⁹/L uncorrected), unavoidable large blood vessels/bowel/severely infected areas in the puncture path, inability to cooperate with breath-holding or immobilization, suspected echinococcosis (puncture may cause anaphylaxis/seeding dissemination), aneurysms, and arteriovenous malformations.

In summary, with its advantages of fine diameter, flexibility, good imaging compatibility, and fewer complications, the Chiba needle has expanded from a simple biopsy tool to an "all-purpose micropuncture needle" in interventional departments, covering multiple roles such as diagnostic biopsy, pre-drainage localization, micro-channel establishment, and local therapeutic drug delivery. It is an indispensable basic instrument in modern interventional radiology.