Risk Factors for Pneumothorax and Bleeding after CT-guided Percutaneous Coaxial Cutting Needle Biopsy of Lung Lesions

Yeow, Kee‐Min; See, Lai‐Chu; Lui, Kar‐Wai; Lin, Meng‐Chih; Tsao, Thomas Chang-Yao; Ng, Kwai‐Fong; Liu, Huiping

doi:10.1016/s1051-0443(07)61556-5

Cited by 274 publications

(382 citation statements)

References 28 publications

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“…The second most common complication observed in percutaneous transthoracic biopsy is parenchymal hemorrhage with an incidence of 5%-10% (11,14,16). In our study, eight patients (8.5%) developed parenchymal hemorrhage, which is consistent with the literature.…”

Section: Discussionsupporting

confidence: 92%

“…In the same study, the authors showed that cases with a lesion size smaller than 2 cm had increased pneumothorax rates in all procedures performed by the radiologists even though needles thinner than 20G were used. Based on these results, the authors stated that pneumothorax rate was not affected by needle size (11). Similarly, Topal and Berkman (12) found no significant relationship between pneumothorax, needle size, and biopsy type in their retrospective study of 284 cases that underwent transthoracic biopsy.…”

Section: Discussionmentioning

confidence: 94%

“…In our study, eight patients (8.5%) developed parenchymal hemorrhage, which is consistent with the literature. Yeow et al (11) suggested that using a fine-needle biopsy would be much safer if pleural effusion was present. In our study, four patients developed hemothorax and two patients developed subcutaneous emphysema after the procedure.…”

Section: Discussionmentioning

confidence: 99%

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CT-guided transthoracic biopsy: histopathologic results and complication rates

Aktaş¹,

Gozlek²,

Yılmaz³

et al. 2015

Diagn Interv Radiol

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 94%

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CT-guided transthoracic biopsy: histopathologic results and complication rates

Aktaş¹,

Gozlek²,

Yılmaz³

et al. 2015

Diagn Interv Radiol

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“…Pulmonary hemorrhage is the second most common complication of pulmonary biopsies, with reported frequencies ranging from 4% to 27% (6,25). In this study pulmonary hemorrhage complications related to the procedure were not different than the studies employing coaxial technique in the literature despite multiple needle passes in the current study.…”

Section: Discussionmentioning

confidence: 42%

Diagnostic accuracy and safety of CT-guided fine needle aspiration biopsy of pulmonary lesions with non-coaxial technique: a single center experience with 442 biopsies

Uzun

Akkaya²,

Atman³

et al. 2017

Diagn Interv Radiol

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CT-guided percutaneous transthoracic biopsy of the lung is a well-established method for diagnosis of pulmonary lesions yielding a diagnostic accuracy of 71%-95% (1-5), with pneumothorax being the most common complication varying between 17% and 26% (5-7). Currently coaxial technique is more commonly employed than the non-coaxial technique. The risk of pneumothorax may play a decisive role on this preference. Theoretically, fewer pleural passes means less risk of pneumothorax with the coaxial technique. However, introduction of relatively large bore needles are needed in the coaxial technique, which is a known risk factor for the development pneumothorax (8,9). To the best of our knowledge, there are only a few studies on CT-guided transthoracic fine needle aspiration (FNA) biopsies with non-coaxial technique on large patient populations (10, 11).The purpose of this retrospective study was to evaluate the diagnostic accuracy and safety of CT-guided transthoracic biopsy of pulmonary lesions with FNA using the non-coaxial technique. Methods PatientsThe institutional review board approved this retrospective study protocol and waived informed consent.CT images and biopsy records were retrospectively evaluated in 442 patients (346 males [78.3%] and 96 females [21.7%]; mean age, 64±10.8 years; range, 22-89 years) who underwent CT-guided transthoracic FNA of pulmonary lesions between July 2011 and June 2015. Bronchoscopy or transbronchial biopsies were nondiagnostic or not feasible in these patients.Exclusion criteria for the procedure were lesions <5 mm in maximum diameter, lesions suspected to be of vascular origin, uncorrectable coagulopathy (international normalized ratio ≥1.5, platelet count <50,000 K/UL), patients who were unable to maintain the appro- I N T E R V E N T I O N A L R A D I O LO G Y O R I G I N A L A R T I C L E PURPOSEWe aimed to evaluate the diagnostic accuracy and safety of computed tomography (CT)-guided biopsy of pulmonary lesions with fine needle aspiration (FNA) using non-coaxial technique. METHODSWe analyzed 442 patients who underwent CT-guided lung biopsy with FNA and non-coaxial technique to determine the diagnostic outcomes, complication rates, and independent risk factors for diagnostic failure and pneumothorax. RESULTSDiagnostic accuracy, sensitivity, and specificity were 97.6%, 97.3%, and 100%, respectively. Age and >35 mm lesion size were significant risk factors for diagnostic failure. The rates of pneumothorax and chest tube placement were 19% and 2.9%, respectively. Middle and lower lobe location, lesion to pleura distance >7.5 mm, and >45° needle trajectory angle were significant risk factors for pneumothorax. CONCLUSIONCT-guided FNA of pulmonary lesions with non-coaxial technique is a safe and reliable method with a relatively low pneumothorax rate and an acceptably high diagnostic accuracy.

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“…Various investigators have analyzed factors thought to affect the diagnostic accuracies and complication rates for CT-guided lung biopsy (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). Risk factors for the development of pulmonary lung biopsy-associated pneumothorax include age, smoking history, lesion volume, lesion position, depth from the pleura to the tumor, biopsy needle angle, and needle thickness (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). Operator experience is also a risk factor (17).…”

Section: Introductionmentioning

confidence: 99%

Computed tomography‑guided lung biopsy: Association between biopsy needle angle and pneumothorax development

et al. 2017

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Abstract. Computed tomography (CT)-guided lung biopsy is a well-established diagnostic method for pulmonary lesions. However, the use of this technique often results in pneumothorax development. The aim of the present study was to evaluate the association between biopsy needle angle and pneumothorax development associated with computed tomography-guided lung biopsy. We retrospectively analyzed the results of CT-guided lung biopsies for 325 cases to investigate physical risk factors for pneumothorax development. Biopsy needle angle and patient positioning were included in the analysis. Pneumothorax occurred in 160 of 325 procedures (49.2%). Discontinuation of the procedure as a result of pneumothorax occurred in 18 of 160 procedures (11.2%). Upper lung lobe pneumothorax occurred in 40.8% (58/142), middle lobe in 17.6% (25/142), and lower lobe pneumothorax occurred in 41.5% (59/142) of these procedures. Discontinuation of the procedure occurred in 2.5% of the upper lobe (4/160), 0.6% of the middle lobe (1/160), and 8.1% of the lower lobe (13/160) biopsies. Mild pneumothorax occurred in 59.4% (95/160), moderate in 25.0% (40/160), and severe in 7.5% (12/160) of the affected cases, and biopsy was discontinued in 11.2% (18/160) of the affected cases. When the needle angle was <90˚, 40.3% (131/325) of the patients experienced no pneumothorax development, 40.0% (130/325) developed pneumothorax, and 4.3% (14/325) of the procedures were discontinued. The results showed that use of CT-guided lung biopsy can reduce the rate of pneumothorax development that occurs when other procedures are used. The access route is simple and easy to puncture, and proper use of breath holding reduces diaphragmatic movement.

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Risk Factors for Pneumothorax and Bleeding after CT-guided Percutaneous Coaxial Cutting Needle Biopsy of Lung Lesions

Cited by 274 publications

References 28 publications

CT-guided transthoracic biopsy: histopathologic results and complication rates

CT-guided transthoracic biopsy: histopathologic results and complication rates

Diagnostic accuracy and safety of CT-guided fine needle aspiration biopsy of pulmonary lesions with non-coaxial technique: a single center experience with 442 biopsies

Computed tomography‑guided lung biopsy: Association between biopsy needle angle and pneumothorax development

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