Patterns of percutaneous transthoracic needle biopsy (PTNB) of the lung and risk of PTNB-related severe pneumothorax: A nationwide population-based study

Abstract

Background As percutaneous transthoracic needle biopsy (PTNB) of the lung is a well-established diagnostic method for the evaluating pulmonary lesions, evidence of safety based on representative data is limited. This study investigated the practice patterns of PTNB of the lung and assessed the incidence and risk factors of PTNB-related severe pneumothorax in Korea. Methods We used a national-level health insurance database between January 1, 2007 and December 31, 2015. Patients who underwent PTNB of the lung were identified using procedure codes for organ biopsy, fluoroscopy, computed tomography, chest radiography, and lungrelated diagnosis codes. The annual age-/sex-standardized rate of PTNB and the incidence of PTNB-related severe pneumothorax were calculated. We defined severe pneumothorax as the pneumothorax requiring intervention. The odds ratios of risk factors were assessed by a generalized estimating equation model with exchangeable working correlation matrix to address clustering effect within institution.

Development And Validation of a Risk Scoring System to Predict Pneumothorax in CT-Guided Percutaneous Transthoracic Needle Biopsy

“…Based on clinical experience and a literature review, we estimated that the risk scoring system for pneumothorax achieved a 70% sensitivity and a 90% speci city. The average prevalence of pneumothorax was approximately 15% in previous studies (2,4,12) . We chose α = 0.05 and maximum marginal error of estimate = 5%.…”

“…Pneumothorax is a common but potentially dangerous complication. In previous studies, the average rate of pneumothorax episodes was reported to range from 1.1 to 29.8% (2,4) , while the development of severe pneumothorax post-biopsy requiring intervention occurred in 1%-14.2% of patients undergoing CT-guided PTNB (2) . The risk factors for pneumothorax have been less studied (1)(2)(3)(4) .…”

“…In previous studies, the average rate of pneumothorax episodes was reported to range from 1.1 to 29.8% (2,4) , while the development of severe pneumothorax post-biopsy requiring intervention occurred in 1%-14.2% of patients undergoing CT-guided PTNB (2) . The risk factors for pneumothorax have been less studied (1)(2)(3)(4) . An evidence-based and easily available risk scoring system for predicting pneumothorax could be valuable for interventionists who perform PTNB.…”

“…Percutaneous transthoracic needle biopsy (PTNB) has been widely used to obtain lung lesion specimens because of its high diagnostic accuracy rate (> 90%) and low complication rate (1,2) . Pneumothorax and pulmonary hemorrhage are the two most common complications caused by PTNB (3) .…”

Diagnostic Accuracy and Complication of Computed Tomography (CT)-Guided Percutaneous Transthoracic Lung Biopsy in Patients 80 Years and Older

“…Percutaneous transthoracic needle lung biopsy (PTNB) is a well-established, minimally invasive procedure for evaluating lung abnormalities with excellent diagnostic accuracy and a low incidence of major complications [ 11 , 12 ]. According to previous studies, age can be a risk factor for complications, and other potential factors include emphysema, large needle, small lesions, increased lesion depth, and increased pleural passage [ 11 , 13 , 14 ]. However, few studies on the accuracy and safety of PTNB in patients 80 years and older [ 15 , 16 ] have been published, and moreover they fail to cover the diagnostic failure rates and their risk factors.…”