Predictors of Technical Success and Rate of Complications of Image-Guided Percutaneous Transthoracic Lung Needle Biopsy of Pulmonary Tumors

Otto, Stephan; Mensel, Birger; Friedrich, Nele; Schäfer, S; Mahlke, Christoph; Bernstorff, Wolfram von; Bock, Karen; Hosten, Norbert; Kühn, Jens‐Peter

doi:10.1371/journal.pone.0124947

Cited by 30 publications

(25 citation statements)

References 27 publications

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“…The rate of biopsy success, which was defined as providing sufficient amount of tissue for histopathologic confirmation of malignant lesion, was 93.4% in our study (93.6% in liver biopsies [US-guided], 89.7% in lung biopsies [CT-guided]). This figure is comparable or higher than those of previous studies on liver [11,12] and lung biopsies [13–16]. Various studies have investigated the factors affecting biopsy success rate, and reported that selecting appropriate target lesion is one of the most important steps for a successful biopsy [8,17].…”

Section: Discussionsupporting

confidence: 71%

Feasibility, safety, and adequacy of research biopsies for cancer clinical trials at an academic medical center

Lee¹,

Lee²,

Yoon³

et al. 2019

PLoS ONE

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Objective Research biopsies are an essential component of cancer clinical trials for studying drug efficacy and identifying biomarkers. Site-level clinical investigators, however, do not have access to results on the adequacy of research biopsies for histological or molecular assays, because samples are sent to central labs and the test results are seldom reported back to site-level investigators unless requested. We evaluated the feasibility, safety, and adequacy of research biopsies performed at an academic medical center. Materials and methods We retrospectively reviewed the data on 122 research biopsy sessions conducted in 99 patients via percutaneous core needle biopsy for 39 clinical trials from January 2017 to February 2018 at a single institute. We asked the sponsors of each clinical trial for the adequacy of the biopsy samples for histological or molecular assays. Results The biopsy success rate was 93.4% (113/122), with nine samples categorized as inadequate for obtaining pathologic diagnosis. Post-biopsy complications occurred in 9.8% (12/122) of biopsies, all of which were mild and completely recovered by the day after the biopsy. The sponsors of clinical trials provided feedbacks on the adequacy of 76 biopsy samples, and noted that a total of 8 biopsy samples from 7 patients were inadequate for analysis, resulting in an adequacy rate of 89.5% (68/76): the reasons for inadequacy were insufficient tumor content for immunohistochemistry (n = 3) and low RNA yield for sequencing (n = 5). Conclusion Research biopsies performed at an experienced, multidisciplinary center had acceptable safety for patients as well as practicality in terms of obtaining adequate tissue samples for molecular studies.

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Section: Discussionsupporting

confidence: 71%

Feasibility, safety, and adequacy of research biopsies for cancer clinical trials at an academic medical center

Lee¹,

Lee²,

Yoon³

et al. 2019

PLoS ONE

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“…The rate of biopsy-related hemoptysis in PTNB ranged from 1.8% to 20.6% in previous studies ( 5 7 8 11 14 17 18 19 20 21 22 23 ). This wide range of hemoptysis may be attributed to the variety of biopsy methods available, operator experience, or the definition of hemoptysis among the studies ( 5 7 8 11 14 17 18 19 20 21 22 23 ). When the studies were limited to CBCT-guided PTNB, the frequency of hemoptysis was 2.0–14.5% ( 7 11 18 19 20 21 23 ).…”

Section: Discussionmentioning

confidence: 84%

Open Bronchus Sign on CT: A Risk Factor for Hemoptysis after Percutaneous Transthoracic Biopsy

et al. 2018

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ObjectiveWe hypothesized that open bronchi within target pulmonary lesions are associated with percutaneous transthoracic needle biopsy (PTNB)-related hemoptysis. We sought to analyze and compare patient characteristics and target features as well as biopsy-related factors between patients with and without PTNB-related hemoptysis.Materials and MethodsWe retrospectively analyzed 1484 patients (870 males and 614 females; median age, 66 years) who had undergone 1569 cone-beam CT (CBCT)-guided PTNBs. Patient characteristics (sex, age, and pathologic diagnosis), nodule features (nodule type, size, location, and presence of an open bronchus in target nodules), and biopsy-related factors (biopsy needle size, pleura-to-target distance, blood test results, open bronchus unavoidability [OBU] index, etc.) were investigated. OBU index, which was assessed using the pre-procedural CBCT, was a subjective scoring system for the probability of needle penetration into the open bronchus. Univariate analysis and subsequent multivariate logistic regression analysis were conducted to reveal the independent risk factors for PTNB-related hemoptysis. For a subgroup of nodules with open bronchi, a trend analysis between the occurrence of hemoptysis and the OBU index was performed.ResultsThe independent risk factors for hemoptysis were sex (female; odds ratio [OR], 1.918; p < 0.001), nodule size (OR, 0.837; p < 0.001), open bronchus (OR, 2.101; p < 0.001), and pleura-to-target distance (OR, 1.135; p = 0.003). For the target nodules with open bronchi, a significant trend between hemoptysis and OBU index (p < 0.001) was observed.ConclusionAn open bronchus in a biopsy target is an independent predictor of hemoptysis, and careful imaging review may potentially reduce PTNB-related hemoptysis.

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“…Pneumothorax is the most frequent complication of CT-guided PTPB with a reported post-procedure incidence ranging between 17–60% [ 6 , 16 , 17 ]. A chest tube placement for pneumothorax therapy is needed in 1%-14% of cases [ 16 – 18 ].…”

Section: Discussionmentioning

confidence: 99%

“…CT-guided PTPB is known to be less risk entailing for the patient compared to surgical procedures, as it is less invasive and still provides a high diagnostic accuracy. The most frequent complication after PTPB is the occurrence of a pneumothorax, which has an incidence of up to 50–60% after PTPB [ 1 – 6 ] and can lead to a considerable reduction in the health state of the patient and longer hospitalization [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Pulmonary emphysema is a predictor of pneumothorax after CT-guided transthoracic pulmonary biopsies of pulmonary nodules

et al. 2017

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PurposePneumothoraces are the most frequently occurring complications of CT-guided percutaneous transthoracic pulmonary biopsies (PTPB). The aim of this study was to evaluate the influence of pre-diagnostic lung emphysema on the incidence and extent of pneumothoraces and to establish a risk stratification for the evaluation of the pre-procedure complication probability.Material and methodsCT-guided PTPB of 100 pre-selected patients (mean age 67.1±12.8 years) were retrospectively enrolled from a single center database of 235 PTPB performed between 2012–2014. Patients were grouped according to pneumothorax appearance directly after PTPB (group I: without pneumothorax, n = 50; group II: with pneumothorax, n = 50). Group II was further divided according to post-interventional treatment (group IIa: chest tube placement, n = 24; group IIb: conservative therapy, n = 26). For each patient pre-diagnostic percentage of emphysema was quantified using CT density analysis. Emphysema stages were compared between groups using bivariate analyses and multinomial logistic regression analyses.ResultsEmphysema percentage was significantly associated with the occurrence of post-interventional pneumothorax (p = 0.006). Adjusted for potential confounders (age, gender, lesion size and length of interventional pathway) the study yielded an OR of 1.07 (p = 0.042). Absolute risk of pneumothorax increased from 43.4% at an emphysema rate of 5% to 73.8% at 25%. No differences could be seen in patients with pneumothorax between percentage of emphysema and mode of therapy (p = 0.721).ConclusionThe rate of lung emphysema is proportionally related to the incidence of pneumothorax after CT-guided PTPB and allows pre-interventional risk stratification. There is no association between stage of emphysema and post-interventional requirement of chest tube placement.

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Predictors of Technical Success and Rate of Complications of Image-Guided Percutaneous Transthoracic Lung Needle Biopsy of Pulmonary Tumors

Cited by 30 publications

References 27 publications

Feasibility, safety, and adequacy of research biopsies for cancer clinical trials at an academic medical center

Feasibility, safety, and adequacy of research biopsies for cancer clinical trials at an academic medical center

Open Bronchus Sign on CT: A Risk Factor for Hemoptysis after Percutaneous Transthoracic Biopsy

Pulmonary emphysema is a predictor of pneumothorax after CT-guided transthoracic pulmonary biopsies of pulmonary nodules

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