Risks of Transthoracic Needle Biopsy

Abstract

Transthoracic needle lung biopsy is a commonly performed diagnostic procedure for pulmonary nodules and masses. To make an informed decision about whether to pursue this procedure, doctors and patients must be aware of the possible risks of the procedure. We performed a MEDLINE search, 2003–2012 to identify relevant English-language studies that included at least 100 subjects and reported data on complications of transthoracic needle lung biopsy performed within the last 10 years. We found the most common complication to be any pneumothorax (risk 15–25%), with pneumothorax requiring chest tube occurring less often (risk 4-6%). Hemorrhage, defined as radiographically visualized blood along the needle tract was common, but clinically significant hemorrhage was infrequent (~1%). Rare complications, including air embolism and tumor seeding of the biopsy tract, occurred in fewer than 1% of cases but were potentially serious. We summarize data on factors associated with complications, including patient age, COPD, lesion size and location, and number of punctures. We also provide data on techniques to mitigate severity of pneumothorax post-biopsy, such as rapid patient rollover, manual aspiration, and instillation of substances into the biopsy tract.

Percutaneous cryoablation for inoperable malignant lung tumors: Midterm results

“…The incidence of pneumothorax in our study was in the range of previous report (12-63%) [30,34]. An important risk factor for pneumothorax in transthoracic needle biopsy is COPD [32]. COPD is characterized by airflow limitation in the peripheral airways due to obstructive or destructive changes, and tends to have alveolar wall rupture and lung collapse [2].…”

A Bronchial Genomic Classifier for the Diagnostic Evaluation of Lung Cancer

“…6 Furthermore, 20 to 25% of surgical biopsies are performed in patients who are ultimately found to have benign lesions. 7,8 Transthoracic needle biopsy is also associated with substantial morbidity, including a 15% rate of pneumothorax 9 and a 6% rate of pneumothorax necessitating chest tube drainage. 10 Given the pitfalls of invasive procedures, alternative approaches are needed to identify patients with a reduced likelihood of cancer who are appropriate candidates for imaging surveillance.…”

Efficacy of a Self-expanding Tract Sealant Device in the Reduction of Pneumothorax and Chest Tube Placement Rates After Percutaneous Lung Biopsy: A Matched Controlled Study Using Propensity Score Analysis

“…[23] Using Medicare claims data from 1997–2008, the total number of biopsies performed by radiologists increased at a compound annual growth rate of 8%, and radiologists’ share of all biopsies increased from 35% to 56%. 23 The use of low dose CT for lung cancer screening 24 , rise in availability of advanced imaging techniques for procedural guidance 23 , and the proliferation of targeted therapies in personalized cancer medicine 25 are but a few factors contributing to this trend of increasing biopsy volume. Indeed, advances in CT technique have evolved so that small nodules which may represent early lung cancer are routinely detected and as a corollary, the professional society guidelines for biopsy are to consider tissue sampling for nodules that are ≥ 8mm.…”