Frequency and Severity of Pulmonary Hemorrhage in Patients Undergoing Percutaneous CT-guided Transthoracic Lung Biopsy: Single-Institution Experience of 1175 Cases

Tai, Ryan; Dunne, Ruth; Trotman‐Dickenson, Beatrice; Jacobson, Francine L.; Madan, Rachna; Kumamaru, Kanako Kunishima; Hunsaker, Andetta R.

doi:10.1148/radiol.2015150381

Cited by 118 publications

(153 citation statements)

References 31 publications

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“…In a comparison of two techniques for TTNB of small subpleural lesions, the long needle-path technique was associated with a higher risk of bleeding than the short needle-path technique (28). Longer transpulmonary needle paths also correspond to more centrally located lesions that are difficult to reach and sometimes require multiple needle reorientations (15,17). However, in our study, bleeding never occurred during needle positioning but only after obtaining at least one sample.…”

Section: Risk Factors For Hemoptysis Following Transthoracic Needle Bcontrasting

confidence: 48%

“…Hemoptysis and alveolar hemorrhage occurred in respectively 18% and 58% of our procedures, values on the high side of previously reported rates. However, as suggested by Tai et al (15), hemoptysis limited to hemorrhagic sputum may have been underreported. The higher rate of hemoptysis in our study may also be related to the use of cutting needles and a coaxial technique, which were found to increase the risk of bleeding in some series (15,16,23) but not in others (17,(23)(24)(25).…”

Section: Discussionmentioning

confidence: 94%

“…An association between female gender and pulmonary bleeding has already been reported, based on both univariate and multivariate analysis (15,16,18). Tai et al (15) have suggested that females may have confounding morbidities, without any further explanation.…”

Section: Discussionmentioning

confidence: 94%

“…Tai et al (15) have suggested that females may have confounding morbidities, without any further explanation. We also found a significant interaction between female gender and smaller lesion size.…”

Section: Discussionmentioning

confidence: 99%

“…Hemoptysis was categorized as mild when limited to hemoptoic sputum, and otherwise as abundant. Alveolar hemorrhage defined as any new ground-glass opacity was considered grade 1 in case of needle tract hemorrhage 2 cm or less in width, grade 2 if measuring more than 2 cm in width, and grade 3 when lobar or greater, as derived from the classification used by Tai et al (15) (Fig. 3).…”

Section: Study Variablesmentioning

confidence: 99%

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Risk factors for hemoptysis complicating 17-18 gauge CT-guided transthoracic needle core biopsy: multivariate analysis of 249 procedures

Chassagnon

Grégory²,

Ahmar³

et al. 2017

Diagn Interv Radiol

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C omputed tomography (CT)-guided transthoracic needle biopsy (TTNB) is a well-established method for investigating pulmonary nodules and masses. It offers a better diagnostic yield than bronchoscopy for the assessment of lung nodules and peripheral lesions (1, 2). Referral for CT-guided TTNB is expected to increase in the coming years. One reason is the higher proportion of adenocarcinomas among current lung cancers, which are more likely to be peripheral and not reachable by bronchoscopy (3, 4). Another reason is the recommendation of re-biopsy for molecular analysis of non-small cell lung cancers that progress or recur (5-7). Although TTNB is considered a safe and efficient method for obtaining a definite pathologic diagnosis, complications are reported in up to two-thirds of procedures (8, 9). The three main complications of TTNB are pneumothorax, alveolar hemorrhage, and hemoptysis. These complications are rarely life threatening, and pulmonary bleeding is usually self-resolving. However, severe hemoptysis can necessitate endobronchial tamponade, arterial embolization, or surgery (8, 10).It is important for the operator to be aware of potentially modifiable risk factors. Several modifiable risk factors for pneumothorax have been reported in the literature, including angle between needle and pleural surface (11), transpulmonary needle-path length (12, 13), patient position during the procedure (11), and operator's level of experience (12). A large pleural angle, a long needle path, the prone position, and limited expertise are all reported to increase the risk of pneumothorax. By contrast, data on risk factors for hemoptysis in this setting are scarce, and most published studies of transthoracic biopsy have combined alveolar hemorrhage and hemoptysis under the term "pulmonary bleeding. " Chakrabarti et al. (14) 347 C H E S T I MAG I N G O R I G I N A L A R T I C L E PURPOSEWe aimed to identify modifiable and nonmodifiable risk factors for hemoptysis complicating computed tomography (CT)-guided transthoracic needle biopsy. METHODSAll procedures performed in our institution from November 2013 to May 2015 were reviewed. Hemoptysis was classified as mild if limited to hemoptoic sputum and abundant otherwise. Presence of intra-alveolar hemorrhage on postbiopsy CT images was also evaluated. Patient-and lesion-related variables were considered nonmodifiable, while procedure-related variables were considered modifiable. RESULTSA total of 249 procedures were evaluated. Hemoptysis and alveolar hemorrhage occurred in 18% and 58% of procedures, respectively, and were abundant or significant in 8% and 17% of procedures, respectively. Concordance between the occurrence of significant alveolar hemorrhage (grade ≥2) and hemoptysis was poor (κ=0.28; 95% CI [0.16-0.40]). In multivariate analysis, female gender (P = 0.008), a longer transpulmonary needle path (P = 0.014), and smaller lesion size (P = 0.044) were independent risk factors for hemoptysis. Transpulmonary needle-path length was the only risk factor for abundant ...

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Section: Risk Factors For Hemoptysis Following Transthoracic Needle Bcontrasting

confidence: 48%

Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Study Variablesmentioning

confidence: 99%

See 3 more Smart Citations

Risk factors for hemoptysis complicating 17-18 gauge CT-guided transthoracic needle core biopsy: multivariate analysis of 249 procedures

Chassagnon

Grégory²,

Ahmar³

et al. 2017

Diagn Interv Radiol

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Success of genomic profiling of non–small cell lung cancer biopsies obtained by trans‐thoracic percutaneous needle biopsy

Gill

Murphy

Kravets

et al. 2018

Journal of Surgical Oncology

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Purpose Genomic profiling for personalized targeted therapy has become standard of care. We report the success of genomic profiling of non–small cell lung cancer (NSCLC) obtained by trans‐thoracic needle biopsy (TTNB) in a single center experience. Materials and Methods Patients with NSCLC who underwent TTNB for genomic were identified. Pathology specimens were evaluated for tumor adequacy and then analyzed for selected exons of epidermal growth factor receptor, KRAS, BRAF, PIK3CA, and ERBB2. ALK rearrangements were detected with fluorescence in situ hybridization and/or immunohistochemistry. Technical success was recorded and the factors affecting successful profiling were evaluated. Complications (pneumothorax, hemorrhage, and admission) were recorded. Comparison of yield and complications were done between the two groups (core biopsy and fine needle aspiration only group). Utility of PET‐CT to guide the needle track for optimized yield was assessed in a subset of patients. Results Between December 6, 2009, and December 30, 2016, 765 patients with NSCLC underwent TTNB. Five‐hundred and seventy‐seven of 765 (75%) of all TTNB were profiled, for genomic analysis. Five‐hundred and eight of 577 (88%) were successfully profiled. The number of samples obtained ranged from 1 to 10 (1 to 2 cm, 18 to 20 G). Lesions biopsied ranged in size from 0.6 to 16 cm. No statistically significant difference was observed in the incidence of pneumothorax between two groups (P = 0.26). PET guidance was not found to be statistically significant ( P = 0.79) in the overall yield. Conclusion Computed tomographic guided TTNB is a safe and efficacious technique for genomic profiling, enables the acquisition of sufficient tissue for genetic mutation analyses allowing for personalized therapy with an acceptable complication rate.

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Hypoxisches Atemversagen bei chronischer Lungenerkrankung

Csernus

Wiebel

Gődény³

et al. 2016

Med Klin Intensivmed Notfmed

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Frequency and Severity of Pulmonary Hemorrhage in Patients Undergoing Percutaneous CT-guided Transthoracic Lung Biopsy: Single-Institution Experience of 1175 Cases

Abstract: Pulmonary hemorrhage after TTLB is common but rarely requires intervention. An enlarged mPAD at CT may not be a risk factor for higher-grade hemorrhage.

Cited by 118 publications

References 31 publications

Risk factors for hemoptysis complicating 17-18 gauge CT-guided transthoracic needle core biopsy: multivariate analysis of 249 procedures

Risk factors for hemoptysis complicating 17-18 gauge CT-guided transthoracic needle core biopsy: multivariate analysis of 249 procedures

Success of genomic profiling of non–small cell lung cancer biopsies obtained by trans‐thoracic percutaneous needle biopsy

Hypoxisches Atemversagen bei chronischer Lungenerkrankung

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