Risk and protective factors of higher-grade intrapulmonary hemorrhage in patients undergoing Percutaneous CT-guided microcoil localization before VATS

Abstract

Background: Even though CT-guided microcoil localization before video-assisted thoracoscopic surgery (VATS) is considered as a safe and effective procedure, related complications are not rare and sometimes are severe. The purpose of this study was to investigate the associated factors of higher-grade intrapulmonary hemorrhage caused by CT-guided microcoil localization. Methods: Totally, 432 consecutive patients with solitary nodule who underwent CT-guided microcoil localization prior to VATS were enrolled in this study. According to CT images after procedure, all the nodules were divided into two groups: higher-grade and no or lower-grade intrapulmonary hemorrhage. The clinical characteristics and microcoil localization procedure-related variables of the nodules were analyzed by univariate analysis and multivariate logistic regression analysis to screen the independent factors associated with higher-grade intrapulmonary hemorrhage. P＜0.05 was considered to indicate a statistically significant difference. Results:Intrapulmonary hemorrhage occurred in 161 of the 432 CT-guided microcoil localizations (37.27%), and higher-grade hemorrhage occurred in 41 of all procedures (9.49%). The logistic regression revealed that repeat insertion (OR=9.712, P<0.001) was the only risk factor for higher-grade intrapulmonary hemorrhage, while procedure-related pneumothorax (OR=0.159, P=0.005), nodule size(>5∽10mm, OR=0.216, P=0.002; >10mm, OR=0.349, P=0.035), pleura-microcoil distance(>20∽30mm, OR=0.365, P=0.018), and lung radiodensity along the needle passage(-850HU∽-900HU, OR=0.426, P=0.032; -900HU or less, OR=0.273, P=0.009) were protective factors for higher-grade intrapulmonary hemorrhage. Conclusions: Repeat insertion was shown to be an independent risk factor for higher-grade hemorrhage in patients with CT-guided microcoil localization. Procedure-related pneumothorax, nodule size(>5mm), pleura-microcoil distance(>20∽30mm), and lung radiodensity along the needle passage(-850HU or less) were protective factors associated with higher-grade hemorrhage.