Population-Based Risk for Complications After Transthoracic Needle Lung Biopsy of a Pulmonary Nodule: An Analysis of Discharge Records

Abstract

Background Because pulmonary nodules are found in up to 25% of patients undergoing chest computed tomography, the question of whether to biopsy is becoming increasingly common. Data on complications following transthoracic needle lung biopsy are limited to case series from selected institutions. Objective To determine population-based estimates of risks of complications following transthoracic needle biopsy of a pulmonary nodule. Design Cross-sectional analysis. Setting The 2006 Healthcare Cost and Utilization Project’s State Ambulatory Surgery Databases and State Inpatient Databases for California, Florida, Michigan, and New York. Patients 15,865 adults who underwent transthoracic needle biopsy of a pulmonary nodule. Measurements Percent of biopsies complicated by hemorrhage, any pneumothorax, and pneumothorax requiring chest tube, and adjusted odds ratios for these complications associated with various biopsy characteristics, calculated using multivariable population-averaged generalized estimating equations. Results Although hemorrhage was rare, complicating 1.0% (95% CI 0.9-1.2%) of biopsies, 17.8% (95% CI 11.8-23.8%) of patients with hemorrhage required a blood transfusion. By contrast, the risk of any pneumothorax was 15.0% (95% CI 14.0-16.0%), and 6.6% (95% CI 6.0-7.2%) of all biopsies resulted in a pneumothorax requiring chest tube. Compared to patients without complications, those who experienced hemorrhage or pneumothorax requiring chest tube had longer lengths of stay (p<0.001) and were more likely to develop respiratory failure requiring mechanical ventilation (p=0.02). Patients aged 60-69 years (as opposed to younger or older patients), smokers, and those with chronic obstructive pulmonary disease had higher risk of complications. Limitations Estimated risks may be inaccurate if coding of complications is incomplete. The databases analyzed contain little clinical detail (e.g., nodule characteristics, biopsy pathology) and cannot determine whether biopsies produced useful information. Conclusion While hemorrhage is an infrequent complication of transthoracic needle lung biopsy, pneumothorax is common and often necessitates chest tube placement. These population-based data should help patients and doctors make a more informed choice on whether to biopsy a pulmonary nodule. Primary Funding Source Department of Veterans Affairs and National Cancer Institute K07 CA 138772

Current Role of Computed Tomography-Guided Transthoracic Needle Biopsy of Metastatic Lung Lesions

“…A recent study on 15.865 adults who had transthoracic needle biopsy of a pulmonary nodule showed that the risk for any pneumothorax was 15.0% (CI: 14.0-16.0%), and 6.6% (CI: 6.0-7.2%) of all biopsies resulted in pneumothorax requiring a chest tube [15]. On the contrary, we did not insert chest drains but again our experience is small.…”

Complications and Economic Burden Associated with Obtaining Tissue for Diagnosis and Molecular Analysis in Patients with Non-Small Cell Lung Cancer (NSCLC) in the US (Preprint)

“…Pneumothorax rates have been reported at 0.5%, 4%, and 15% for EBUS-TBNA, transbronchial biopsy and transthoracic needle aspiration, respectively [24,25,10]. In the current study, the number of patients who received EBUS-TBNA was not documented, and therefore the impact on the results is unknown.…”

“…Based on a literature review of complications associated with rebiopsy [8][9][10], the data were searched for the following complications: pneumothorax, hemorrhage, bronchial spasms, arrhythmia, severe chest pain, light headedness, trouble breathing, excessive bleeding, hemoptysis, fever, and death.…”

Adequacy of Transthoracic Needle Biopsy Samples in the Diagnosis of a Peripheral Lung Lesion – Comparing Success Rates of Various Imaging Modalities

“…[16][17][18] Due to this reason, the American College of Chest Physicians recommends TTNA for lung nodules present without a bronchus sign only when RP-EBUS (radial endobronchial ultrasound) is not available. [13] Although transthoracic needle aspiration is a technically demanding procedure, documented evidence has shown that it is accurate with limited morbidity.…”

“…[14,15] Various groups have shown lower pneumothorax rates for Fluoroscopy guided transthoracic needle biopsies. [14][15][16][17][18] The only drawback of using Fluoroscopy is the risk of exposure to radiation for both patients and radiologists, which can be minimized by using the 'quick check' method. [20,21] Ultrasound guided TTNA biopsies are generally well tolerated probably because lung lesions guided by ultrasounds are peripheral in nature with less chances of pneumothorax.…”