Transthoracic Needle Aspiration Biopsy: Variables That Affect Risk of Pneumothorax

Cox, Joseph E.; Chiles, Caroline; McManus, Christopher M.; Aquino, Suzanne L.; Choplin, Robert H.

doi:10.1148/radiology.212.1.r99jl33165

Cited by 285 publications

(225 citation statements)

References 25 publications

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“…The technique appears to be relatively safe, because these figures are lower than most of the previous studies, where the rate of pneumothorax ranges from 17% to 26.6%, and that of chest tube insertion from 1% to 14.2% (5)(6)(7). Although the number of pleural passes is less with the coaxial technique, this was not shown to correlate with decreased risk of pneumothorax in various studies (9,19,20). However, this topic is controversial because studies by Kuban et al (8) and Nour-Eldin et al (21) stated the contrary.…”

Section: Discussionmentioning

confidence: 84%

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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Section: Discussionmentioning

confidence: 84%

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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“…4,48 TTNA does have a 90% chance of confi rming a diagnosis (range, 76% to 90%), but some report a pneumothorax rate as high as 40%. 4,5,[49][50][51][52][53][54][55][56][57] Additionally, the diagnostic yield is infl uenced by the size of the lesion, the size of the needle, the number of passes, and the presence of rapid on-site evaluation. 4,5,[53][54][55][56] The location of the lesion in the lungs, peripheral vs central, may also infl uence the diagnostic yield of TTNA.…”

Section: Discussionmentioning

confidence: 99%

Meta-analysis of Guided Bronchoscopy for the Evaluation of the Pulmonary Nodule

Memoli

Nietert

Silvestri

2012

Chest

545

496

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385 PULMONARY PROCEDURESsuspicious for lung cancer. 2 With the fi ndings of the NLST indicating a reduction in lung-cancer-specifi c mortality with CT scanning in at-risk people, the number of patients diagnosed with a PN could increase substantially if screening for lung cancer is broadly T he pulmonary nodule (PN) is becoming an increasingly common radiographic fi nding among patients in the United States. Nearly 45 million CT scan examinations are performed each year, and 11% to 30% (4.5-14 million) of those include an examination of the chest. 1 In the recently released National Cancer Institute-sponsored National Lung Screening Trial (NLST), . 25% of the group who underwent lowdose CT scans of the chest had examinations that were Background: The detection of pulmonary nodules (PNs) is likely to increase, especially with the release of the National Lung Screen Trials. When tissue diagnosis is desired, transthoracic needle aspiration (TTNA) is recommended. Several guided-bronchoscopy technologies have been developed to improve the yield of transbronchial biopsy for PN diagnosis: electromagnetic navigation bronchoscopy (ENB ), virtual bronchoscopy (VB), radial endobronchial ultrasound (R-EBUS), ultrathin bronchoscope, and guide sheath. We undertook this meta-analysis to determine the overall diagnostic yield of guided bronchoscopy using one or a combination of the modalities described here. Methods: We performed a MEDLINE search using "bronchoscopy" and "solitary pulmonary nodule." Studies evaluating the diagnostic yield of ENB, VB, R-EBUS, ultrathin bronchoscope, and/or guide sheath for peripheral nodules were included. The overall diagnostic yield and yield based on size were extracted. Adverse events, if reported, were recorded. Meta-analysis techniques incorporating inverse variance weighting and a random-effects meta-analysis approach were used. Results: A total of 3,052 lesions from 39 studies were included. The pooled diagnostic yield was 70%, which is higher than the yield for traditional transbronchial biopsy. The yield increased as the lesion size increased. The pneumothorax rate was 1.5%, which is signifi cantly smaller than that reported for TTNA. Conclusion: This meta-analysis shows that the diagnostic yield of guided bronchoscopic techniques is better than that of traditional transbronchial biopsy. Although the yield remains lower than that of TTNA, the procedural risk is lower. Guided bronchoscopy may be an alternative or be complementary to TTNA for tissue sampling of PN, but further study is needed to determine its role in the evaluation of peripheral pulmonary lesions.CHEST 2012; 142(2):385-393Abbreviations: ENB 5 electromagnetic navigation bronchoscopy; NLST 5 National Lung Screening Trial; PN 5 pulmonary nodule; R-EBUS 5 radial endobronchial ultrasound; TTNA 5 transthoracic needle aspiration; VB 5 virtual bronchoscopy

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“…The most common complication of CT scan-guided lung biopsy is pneumothorax, with a frequency ranging from 17.9% [25] to 54.3% [7,25,[26][27][28][29][30][31][32]. Haemoptysis is also well known as a biopsy-induced complication, with a frequency ranging from 2.0% [32] to 10.1% [6].…”

Section: Discussionmentioning

confidence: 99%

Comparison of fully automated and semi-automated biopsy needles for lung biopsy under CT fluoroscopic guidance

Yoshimatsu

Yamagami²,

Tanaka³

et al. 2012

BJR

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Transthoracic Needle Aspiration Biopsy: Variables That Affect Risk of Pneumothorax

Abstract: Smaller lesion size and emphysema are strongly correlated with occurrence of pneumothorax. Pneumothorax was more than three times less frequent if no aerated lung was traversed. After pneumothorax, chest tube placements were related to the presence of emphysema.

Cited by 285 publications

References 25 publications

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

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

Meta-analysis of Guided Bronchoscopy for the Evaluation of the Pulmonary Nodule

Comparison of fully automated and semi-automated biopsy needles for lung biopsy under CT fluoroscopic guidance

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