Pneumothorax and pulmonary hemorrhage after CT-guided lung biopsy: incidence, clinical significance and correlation

Sabatino, Vittorio; Russo, Umberto; D’Amuri, Fabiano; Bevilacqua, Antonella; Pagnini, Francesco; Milanese, Gianluca; Gentili, Francesco; Nizzoli, Rita; Tiseo, Marcello; Pedrazzi, Giuseppe; Filippo, Massimo De

doi:10.1007/s11547-020-01211-0

Cited by 21 publications

(29 citation statements)

References 23 publications

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“…Of the 19 cases resulting non-diagnostic for FNAB, 10 were carcinoma (10/28, 35%), 4 thymomas (4/6, 66%), 2 lymphomas (2/11, 18%), 1 fibrosarcoma (1/11.9%) and 1 inflammatory/infectious (1/11.9%). Surprisingly, in carcinomas and thymomas, the percentage of non-diagnostic samples at the cytology was relatively high even if they are strongly exfoliative lesions [ 19 ]. In our study, this could be explained because in some cases carcinomas and thymomas, being intrathoracic lesions, can be more difficult to be biopsied than masses of the thoracic wall.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, the use of the Doppler examination allows the evaluation of the lesion vascularization [ 1 ]. Nevertheless, in human medicine, CT and CT-guided biopsies, both FNAB and TCB, are recommended in the presence of thoracic lesions which are not adequately visible or accessible with other procedures [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ]. CT-guide sampling has been reported to be diagnostic in 75–95% of human patients [ 10 , 19 , 20 , 21 ].…”

Section: Introductionmentioning

confidence: 99%

“…Nevertheless, in human medicine, CT and CT-guided biopsies, both FNAB and TCB, are recommended in the presence of thoracic lesions which are not adequately visible or accessible with other procedures [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ]. CT-guide sampling has been reported to be diagnostic in 75–95% of human patients [ 10 , 19 , 20 , 21 ]. On the other hand, indications for CT-guided biopsy in dogs and cats include lesions not well identified on radiographs or with fluoroscopy, lesions close to vascular structures, small lesions and lesions surrounded by air or gas which would not be identified with US [ 23 , 24 , 25 , 26 ].…”

Section: Introductionmentioning

confidence: 99%

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Clinical Value of CT-Guided Fine Needle Aspiration and Tissue-Core Biopsy of Thoracic Masses in the Dog and Cat

Vignoli

Tamburro

Felici

et al. 2021

Animals

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Diagnosis of thoracic lesions on the basis of history and physical examination is often challenging. Diagnostic imaging is therefore of paramount importance in this field. Radiology has traditionally been considered the diagnostic procedure of choice for these diseases. Nevertheless, it is often not possible to differentiate inflammatory/infectious lesions from neoplastic diseases. A correct cytological and histopathologic diagnosis is therefore needed for an accurate diagnosis and subsequent prognostic and therapeutic approach. In human medicine, Computed Tomography (CT) and CT-guided biopsy are used in the presence of lesions which are not adequately diagnosed with other procedures. In the present study, thoracic lesions from 52 dogs and 10 cats of different sex, breed and size underwent both CT-guided fine-needle aspiration (FNAB) and tissue-core biopsy (TCB). Clinical examination, hematobiochemical analysis and chest radiography were performed on all animals. In this study, 59 of 62 histopathological samples were diagnostic (95.2%). Cytology was diagnostic in 43 of 62 samples (69.4%). General sensitivity, accuracy and PPV for FNAB and TCB were 67.7%, 67.7% and 100% and 96.7%, 95.2% and 98.3%, respectively. Combining the two techniques, the overall mean accuracy for diagnosis was 98.4%. Nineteen of 62 cases showed complications (30.6%). Mild pneumothorax was seen in 16 cases, whereas mild hemorrhage occurred in three cases. No major complications were encountered. CT-guided FNAB cytology can be considered a useful and reliable technique, especially for small lesions or lesions located close to vital organs and therefore dangerous to biopsy in other way.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clinical Value of CT-Guided Fine Needle Aspiration and Tissue-Core Biopsy of Thoracic Masses in the Dog and Cat

Vignoli

Tamburro

Felici

et al. 2021

Animals

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“…Pneumothorax is the most frequent and potentially dangerous complication after lung biopsy, despite the majority of patients remaining asymptomatic and not requiring further treatment. 3,4 The complication of a pneumothorax per se is not highly problematic, but chest pain, shortness of breath, and hypoxia caused by pneumothorax may increase the need for chest tube placement and patient hospitalization.…”

Section: Introductionmentioning

confidence: 99%

“…Those results are consistent with the premise that pulmonary hemorrhage along the needle track represents a protective factor against the development of pneumothorax. 3 A possible physiological mechanism is that the substances fill the biopsy tract, thus creating a barrier, which prevents air from traveling from the alveoli to the negative pressure zone of the pleural space.…”

mentioning

confidence: 99%

Pneumothorax Induced by Computed Tomography Guided Transthoracic Needle Biopsy: A Review for the Clinician

Zeng

Liao

Ren

et al. 2021

IJGM

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Percutaneous computed tomography (CT)-guided transthoracic needle biopsy (TTNB) is a valuable procedure for obtaining tissue or cells for diagnosis, which is especially indispensable in thoracic oncology. Pneumothorax and hemoptysis are the most common complications of percutaneous needle biopsy of the lung. According to reports published over the past decades, pneumothorax incidence in patients who underwent TTNB greatly varies. The morbidity of pneumothorax after CT-guided TTNB depends on several factors, including size and depth of lesions, emphysema, the number of pleural surfaces and fissure crossed, etc. Attention to biopsy planning and technique and post-biopsy precautions help to prevent or minimize potential complications. Many measures can be taken to help prevent the progression of a pneumothorax, which in turn might reduce the number of pneumothoraces requiring chest tube placement. A multitude of therapeutic options is available for the treatment of pneumothorax, varying from observation and oxygen treatment, simple manual aspiration, to chest tube placement. When a pneumothorax develops during the biopsy procedure, it can be manually aspirated after the needle is retracted back into the pleural space or by inserting a separate needle into the pleural space. Biopsy side down positioning of the patient after biopsy significantly reduces the incidence of pneumothorax and the requirement of chest tube placement. Aspiration in biopsy side down position is also recommended for treating pneumothorax when simple manual aspiration is unsuccessful or delayed pneumothorax occurred. Chest tube placement is an important treatment strategy for patients with a large or symptomatic pneumothorax. Clinicians are encouraged to understand the development, prevention, and treatment of pneumothorax. Efforts should be made to reduce the incidence of pneumothorax in biopsy planning and post-biopsy precautions. When pneumothorax occurs, appropriate treatment should be adopted to reduce the risk of worsening pneumothorax.

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Current investigative modalities for detecting and staging lung cancers: a comprehensive summary

Philip

Jain

Wojtowicz

et al. 2022

Indian J Thorac Cardiovasc Surg

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Pneumothorax and pulmonary hemorrhage after CT-guided lung biopsy: incidence, clinical significance and correlation

Cited by 21 publications

References 23 publications

Clinical Value of CT-Guided Fine Needle Aspiration and Tissue-Core Biopsy of Thoracic Masses in the Dog and Cat

Clinical Value of CT-Guided Fine Needle Aspiration and Tissue-Core Biopsy of Thoracic Masses in the Dog and Cat

Pneumothorax Induced by Computed Tomography Guided Transthoracic Needle Biopsy: A Review for the Clinician

Current investigative modalities for detecting and staging lung cancers: a comprehensive summary

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