Computed Tomography–guided Percutaneous Lung Biopsy

Abstract

The odds of nondiagnostic biopsy increase for lesions closer to the diaphragm; however, the odds of pneumothorax are not significantly different.

Cone-Beam CT-Guided Percutaneous Transthoracic Needle Lung Biopsy of Juxtaphrenic Lesions: Diagnostic Accuracy and Complications

“…The complication rate of cone-beam CT-guided PTNB of juxtaphrenic lesions was 29.2% in this study. Pneumothorax occurred after 26.5% of PTNBs, which is within the previously reported range of 16.2–38.4% [ 2 4 11 12 14 18 19 20 ]. Significant risk factors for pneumothorax were old age, presence of emphysema, small target size, and deep location, all of which are consistent with prior studies [ 4 9 10 14 21 22 23 ].…”

“…The reported risk factors for diagnostic failure of PTNB include a small target lesion, a benign final diagnosis, and the use of fine-needle aspiration (FNA) as the diagnostic method [ 4 5 6 ]. A lower lobar location of the target lesion is also known to be associated with both diagnostic failure and the occurrence of pneumothorax [ 4 8 9 10 11 12 ]. However, the relationships between diagnostic failure or complications and the abutment of the diaphragm by the target lesion have not yet been established, although in practice, radiologists find the procedure more challenging when the target lesion is located adjacent to the diaphragm because it is strongly affected by respiratory motion.…”

“…There is a risk of abdominal solid organ injury, and needle trajectory planning is limited. Some lesions are not sufficiently visible on fluoroscopy [ 12 13 ]. Patel et al [ 12 ] investigated the impact of target lesion proximity to the diaphragm on biopsy yield and pneumothorax risk, but in their study, the mean distance of target lesions from the diaphragm was 8.3 cm, which was far from a juxtaphrenic location.…”

“…Some lesions are not sufficiently visible on fluoroscopy [ 12 13 ]. Patel et al [ 12 ] investigated the impact of target lesion proximity to the diaphragm on biopsy yield and pneumothorax risk, but in their study, the mean distance of target lesions from the diaphragm was 8.3 cm, which was far from a juxtaphrenic location. To the best of our knowledge, the diagnostic accuracy and complication rate of PTNB for juxtaphrenic lesions have not been evaluated in prior studies.…”

Nomogram model to predict pneumothorax after computed tomography-guided coaxial core needle lung biopsy

“…Pneumothorax triggers short of breath, chest pain or can even be life-threatening, which leads to prolonged inpatient stay and increased economic burden [14,15]. To reduce the incidence of pneumothorax after CCNBs, studies have explored the related risk factors, including patient characteristics (age [16], sex [17]), primary pulmonary disease (emphysema [16][17][18][19]) and biopsy variables (lesion size, Abbreviations: CCNB, coaxial core needle lung biopsy; CT, computed tomography; PTNB, percutaneous transthoracic needle biopsy; AUC, area under the curve; APTT, activated partial thromboplastin time; BMI, body mass index; D-D, D-dimer; FDP, fibrinogen degradation products; FIB, fibrinogen; PLT, platelets; PT, prothrombin time; PTNB, percutaneous transthoracic needle biopsy RBC red blood cells; TT, thrombin time; WBC, white blood cells; OR, odds ratio; CI, confidence interval.…”