Incidence of and Risk Factors for Pneumothorax and Chest Tube Placement After CT Fluoroscopy–Guided Percutaneous Lung Biopsy: Retrospective Analysis of the Procedures Conducted Over a 9-Year Period

Hiraki, Takao; Mimura, Hidefumi; Gobara, Hideo; Shibamoto, Kentaro; Inoue, Dai; Matsui, Yusuke; Kanazawa, Susumu

doi:10.2214/ajr.09.3224

Cited by 178 publications

(182 citation statements)

References 37 publications

Supporting

Mentioning

143

Contrasting

Unclassified

Order By: Relevance

“…We defined the needle entry angle as the latter. Our results were in compliance with the previous studies (20,22,23). More than 45° of entry angle was a risk factor for pneumothorax causing a wider hole in the pleura if the needle crosses the pleura in an oblique fashion.…”

Section: Discussionsupporting

confidence: 92%

“…The lesion to pleura distance was also a significant factor for pneumothorax in this study and in some other studies in the literature (4,8,(21)(22)(23)(24). In the literature, the needle entry angle is either defined as the angle between the pleura and needle axis or the line perpendicular to the pleura at the entry point and needle axis.…”

Section: Discussionsupporting

confidence: 63%

“…No significant relationship between the number of samplings and diagnostic accuracy was noted in our study, but in the study by Hiraki et al (2), the number of samplings appears to be a significant factor for diagnostic failure. Pneumothorax following biopsies of middle and lower lung lesions were more prevalent compared with upper lobe lesions in this study and in the literature (21,22). This may be related to the effect of diaphragmatic movements on middle and lower lung lobes and excessive movement of the biopsy needle during the procedure by respiration, widening the puncture hole in the pleura resulting in a higher pneumothorax risk.…”

Section: Discussionsupporting

confidence: 45%

See 2 more Smart Citations

Diagnostic accuracy and safety of CT-guided fine needle aspiration biopsy of pulmonary lesions with non-coaxial technique: a single center experience with 442 biopsies

Uzun

Akkaya²,

Atman³

et al. 2017

Diagn Interv Radiol

View full text Add to dashboard Cite

CT-guided percutaneous transthoracic biopsy of the lung is a well-established method for diagnosis of pulmonary lesions yielding a diagnostic accuracy of 71%-95% (1-5), with pneumothorax being the most common complication varying between 17% and 26% (5-7). Currently coaxial technique is more commonly employed than the non-coaxial technique. The risk of pneumothorax may play a decisive role on this preference. Theoretically, fewer pleural passes means less risk of pneumothorax with the coaxial technique. However, introduction of relatively large bore needles are needed in the coaxial technique, which is a known risk factor for the development pneumothorax (8,9). To the best of our knowledge, there are only a few studies on CT-guided transthoracic fine needle aspiration (FNA) biopsies with non-coaxial technique on large patient populations (10, 11).The purpose of this retrospective study was to evaluate the diagnostic accuracy and safety of CT-guided transthoracic biopsy of pulmonary lesions with FNA using the non-coaxial technique. Methods PatientsThe institutional review board approved this retrospective study protocol and waived informed consent.CT images and biopsy records were retrospectively evaluated in 442 patients (346 males [78.3%] and 96 females [21.7%]; mean age, 64±10.8 years; range, 22-89 years) who underwent CT-guided transthoracic FNA of pulmonary lesions between July 2011 and June 2015. Bronchoscopy or transbronchial biopsies were nondiagnostic or not feasible in these patients.Exclusion criteria for the procedure were lesions <5 mm in maximum diameter, lesions suspected to be of vascular origin, uncorrectable coagulopathy (international normalized ratio ≥1.5, platelet count <50,000 K/UL), patients who were unable to maintain the appro- I N T E R V E N T I O N A L R A D I O LO G Y O R I G I N A L A R T I C L E PURPOSEWe aimed to evaluate the diagnostic accuracy and safety of computed tomography (CT)-guided biopsy of pulmonary lesions with fine needle aspiration (FNA) using non-coaxial technique. METHODSWe analyzed 442 patients who underwent CT-guided lung biopsy with FNA and non-coaxial technique to determine the diagnostic outcomes, complication rates, and independent risk factors for diagnostic failure and pneumothorax. RESULTSDiagnostic accuracy, sensitivity, and specificity were 97.6%, 97.3%, and 100%, respectively. Age and >35 mm lesion size were significant risk factors for diagnostic failure. The rates of pneumothorax and chest tube placement were 19% and 2.9%, respectively. Middle and lower lobe location, lesion to pleura distance >7.5 mm, and >45° needle trajectory angle were significant risk factors for pneumothorax. CONCLUSIONCT-guided FNA of pulmonary lesions with non-coaxial technique is a safe and reliable method with a relatively low pneumothorax rate and an acceptably high diagnostic accuracy.

show abstract

Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 63%

Section: Discussionsupporting

confidence: 45%

See 1 more Smart Citation

Diagnostic accuracy and safety of CT-guided fine needle aspiration biopsy of pulmonary lesions with non-coaxial technique: a single center experience with 442 biopsies

Uzun

Akkaya²,

Atman³

et al. 2017

Diagn Interv Radiol

View full text Add to dashboard Cite

show abstract

“…Potential complications of CT-guided needle biopsy include pneumothorax, hemoptysis, infection, implant transfer, and air embolism (12)(13)(14)(15)(16)(17)(18)(19)(20). Pneumothorax is a common and potentially life-threatening complication of puncturing the thorax.…”

Section: Introductionmentioning

confidence: 99%

Logistic regression analysis and a risk prediction model of pneumothorax after CT-guided needle biopsy

Zhao¹,

Wang²,

Wang³

et al. 2017

J. Thorac. Dis.

View full text Add to dashboard Cite

Background: Pneumothorax is the most common complication of computed tomography (CT)-guided needle biopsy. The purpose of this study was to investigate independent risk factors of pneumothorax, other than emphysema, after CT-guided needle biopsy and to establish a risk prediction model. Methods: A total of 864 cases of CT-guided needle biopsy with an 18-gauge cutting needle were enrolled in this study. The relevant risk factors associated with pneumothorax included age, sex, emphysema, shortaxis size of the lesion, depth of the lesion, body position, and the number of pleural punctures. Several independent risk factors of pneumothorax were found, and a predictive model for pneumothorax was established using univariate and multivariate logistic regression analyses. Results: Pneumothorax occurred in 31.4% (271/864) of cases. Univariate analysis showed that significant risk factors of pneumothorax included age, emphysema, small lesion size, no contact between the lesion and the pleura, prone or lateral body position, and multiple punctures. Independent risk factors of pneumothorax in the multivariate logistic regression analysis included emphysema (P=0.000), no contact between the lesion and the pleura (P=0.000), prone or lateral body position (P=0.002), and the number of pleural punctures (P=0.000). The sensitivity, specificity, and accuracy of the predictive model for pneumothorax were 56.8%, 79.6%, and 72.5%, respectively. Conclusions: Pneumothorax is a common complication of CT-guided lung biopsy. Independent risk factors of pneumothorax include emphysema, no contact between the lesion and the pleura, and prone or lateral body position. The predictive model developed in this study was highly accurate in predicting the incidence of pneumothorax.

show abstract

“…The presence of COPD may be a risk factor [14•, 16, 17] as well as a smaller needlepleural angle when taking the biopsy [18,19]. Some studies suggest that the deeper the lesion being biopsied, the higher the risk of pneumothorax [17,19], but this finding is not consistent across all studies [18,20].…”

Section: Iatrogenic Pneumothoraxmentioning

confidence: 99%

Common iatrogenic pleural complications

Dunscombe

Maskell

2012

Curr Respir Care Rep

View full text Add to dashboard Cite

All invasive pleural procedures have the potential to cause harm. Complications from pleural procedures include empyema, intercostal artery laceration, hemothorax, and pneumothorax as well as other organ puncture. Many of these complications will be life threatening and will increase morbidity and hospital length of stay. An understanding of iatrogenic pleural disease helps clinicians to appreciate how these risks can be minimized and complications managed promptly and effectively. This review systematically evaluates the current evidence and guidelines regarding iatrogenic pleural complications and their management. Whilst impossible to eliminate procedural risk entirely, complications will be reduced to a minimum by ensuring adequate medical training, use of pleural ultrasound, and adherence to guidelines and standard operating procedures (SOPs).

show abstract

Incidence of and Risk Factors for Pneumothorax and Chest Tube Placement After CT Fluoroscopy–Guided Percutaneous Lung Biopsy: Retrospective Analysis of the Procedures Conducted Over a 9-Year Period

Abstract: Pneumothorax frequently occurred and placement of a chest tube was occasionally required for pneumothorax after CT fluoroscopy-guided lung biopsy. To reduce the risk of pneumothorax necessitating chest tube placement, physicians should adopt the shortest needle path to the lesion.

Cited by 178 publications

References 37 publications

Diagnostic accuracy and safety of CT-guided fine needle aspiration biopsy of pulmonary lesions with non-coaxial technique: a single center experience with 442 biopsies

Diagnostic accuracy and safety of CT-guided fine needle aspiration biopsy of pulmonary lesions with non-coaxial technique: a single center experience with 442 biopsies

Logistic regression analysis and a risk prediction model of pneumothorax after CT-guided needle biopsy

Common iatrogenic pleural complications

Contact Info

Product

Resources

About