Use of Spirometry to Predict Risk of Pneumothorax in CT-Guided Needle Biopsy of the Lung

García‐Río, Francisco; Pino, Jesús; Casadevall, J; Gomez, Luis G.; Atienza, J. M.; Díaz-Lobato, Salvador; Villamor, J.

doi:10.1097/00004728-199601000-00005

Cited by 42 publications

(42 citation statements)

References 14 publications

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“…It is generally accepted that patients with a long-term smoking history and severe chronic obstructive lung disease (COPD) are at greater risk for adverse complications from the procedure. The severity of the underlying lung disease has been reported to be one of the determining risk factors for pneumothorax [3,4,5,6,7]. The trend in percutaneous needle biopsy technique has been to replace FNAB with core-needle biopsy in order to reduce the frequency of nondiagnostic biopsy procedures [11,12,13].…”

Section: Discussionmentioning

confidence: 99%

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Ultrathin needle (25�G) aspiration lung biopsy: diagnostic accuracy and complication rates

et al. 2004

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The aim of this study was to evaluate the diagnostic accuracy and complication rate of 25-G fine-needle aspiration biopsy (FNAB) of the lung in patients with suspected malignant focal lesions and abnormal lung function. The 25-G FNAB was performed in 123 patients who underwent prebiopsy CT and pulmonary function tests. Retrospective evaluation included pulmonary function, cytology, size of the lesion, depth of location, presence of emphysema on CT, needle passes, pneumothorax and drainage. The final diagnosis (gold standard) was based on histopathology after surgical resection or follow-up and response to treatment. Sixty-one patients had normal lung function or mild impairment (group 1) and 62 had moderate or severe impairment (group 2). Pneumothorax occurred in 26 of 126 procedures (20.6%) with drainage needed in 11 (8.7%). In group 2 pneumothorax occurred in 19 of 63 procedures (30.15%) with drainage needed in 11 (17.5%). The sensitivity, specificity and diagnostic accuracy of cytology results were 93.6, 100 and 94.4%, respectively. FEV1 ( p=0.014), FEV1/FVC ( p=0.005), FEF25-75 ( p=0.001), DLCO ( p=0.013) and presence of emphysema on CT ( p<0.001) correlated with pneumothorax (Student's t test). The 25-G lung FNAB is accurate and safe in diagnosing malignancy in patients with severe lung functional abnormality. Patients with moderate to severe airway obstruction have a higher prevalence of pneumothorax than patients with mild or no functional impairment.

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Section: Discussionmentioning

confidence: 99%

“…The reported incidence ranges from 8 to 54%, with 1.6-17% of patients requiring chest tube drainage [1,3]. Chronic obstructive pulmonary disease (COPD) is considered to be one of the primary contributing factors for the development of post-FNAB pneumothorax [3,4,5,6,7].…”

Section: Introductionmentioning

confidence: 99%

Ultrathin needle (25�G) aspiration lung biopsy: diagnostic accuracy and complication rates

et al. 2004

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“…In COPD, more severe disease with FEV 1 less than 1 L has been reported to be associated with increased risk of developing secondary spontaneous pneumothorax (1,19). The risk of iatrogenic pneumothorax has been associated with the qualitative appearance of emphysema on chest CT scans (20,21). The association of iatrogenic pneumothorax with spirometry values is not clear, as two studies have showed inconsistent results (21,22).…”

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confidence: 99%

“…The risk of iatrogenic pneumothorax has been associated with the qualitative appearance of emphysema on chest CT scans (20,21). The association of iatrogenic pneumothorax with spirometry values is not clear, as two studies have showed inconsistent results (21,22).…”

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confidence: 99%

Pneumothorax Risk Factors in Smokers with and without Chronic Obstructive Pulmonary Disease

Hobbs¹,

Bowler²,

Jacobson³

et al. 2014

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Rationale: The demographic, physiological, and computed tomography (CT) features associated with pneumothorax in smokers with and without chronic obstructive pulmonary disease (COPD) are not clearly defined.Objectives: We evaluated the hypothesis that pneumothorax in smokers is associated with male sex, tall and thin stature, airflow obstruction, and increased total and subpleural emphysema. Methods:The study included smokers with and without COPD from the COPDGene Study, with quantitative chest CT analysis. Pleural-based emphysema was assessed on the basis of local histogram measures of emphysema. Pneumothorax history was defined by subject self-report.Measurements and Main Results: Pneumothorax was reported in 286 (3.2%) of 9,062 participants. In all participants, risk of prior pneumothorax was significantly higher in men (odds ratio [OR], 1.55; 95% confidence interval [CI], 1.08-2.22) and non-Hispanic white subjects (OR, 1.90; 95% CI, 1.34-2.69). Risk of prior pneumothorax was associated with increased percent CT emphysema in all participants and participants with COPD (OR, 1.04 for each 1% increase in emphysema; 95% CI, 1.03-1.06). Increased pleural-based emphysema was independently associated with risk of past pneumothorax in all participants (OR, 1.05 for each 1% increase; 95% CI, 1.01-1.10). In smokers with normal spirometry, risk of past pneumothorax was associated with non-Hispanic white race and lifetime smoking intensity (OR, 1.20 for every 10 pack-years; 95% CI, 1.09-1.33).Conclusions: Among smokers, pneumothorax is associated with male sex, non-Hispanic white race, and increased percentage of total and subpleural CT emphysema. Pneumothorax was not independently associated with height or lung function, even in participants with COPD.Clinical trial registered with www.clinicaltrials.gov (NCT00608764).

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“…The severity of underlying lung disease has been correlated with the rate of pneumothorax during percutaneous needle aspiration [64, 65, 66, 67, 68, 69]. No similar bronchoscopic studies exist.…”

Section: Discussionmentioning

confidence: 99%

Contraindications and Safety of Transbronchial Lung Biopsy via Flexible Bronchoscopy

et al. 2005

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Background: Transbronchial lung biopsy (TBLB) via flexible bronchoscopy is a common procedure performed by pulmonologists. Limited scientific data exist concerning the risk of this procedure in patients with conditions that may adversely affect the rate of procedural complications. Objectives: To evaluate the current practice pattern and attitude of pulmonologists toward the performance of TBLB in the presence of high-risk conditions. Methods: A survey was constructed and distributed at the American College of Chest Physicians annual meeting, held in Philadelphia, USA, in November of 2001. Results: A total of 227 surveys were distributed with a return of 158 (69.6%). Anticoagulation medications are temporarily held prior to TBLB by the majority of our survey respondents (98.7% for intravenous heparin, 90.5% for warfarin, and 87.3% for low-molecular-weight heparin). Medications with effect on platelet function are held by fewer pulmonologists. There is a wide variation in the pulmonologists’ perception of the risk of performing TBLB when certain medical conditions coexist: pulmonary hypertension [absolute contraindication (AC), 28.7%; relative contraindication (RC) 58.6%], superior vena cava syndrome (AC 19.6%, RC 51%), mechanical ventilation (AC 17.8%, RC 58.6%) and lung cavity/abscess (AC 7%, RC 44.9%). A significant percentage of pulmonologists (55%) do not regard an elevated serum creatinine at any level as AC to TBLB. Thirty-eight percent of the survey participants administer desmopressin prior to TBLB in uremic patients to prevent excessive bleeding. Conclusions: Prior to performing bronchoscopic TBLB, the majority of pulmonologists temporarily holds anticoagulation medications. However, there is a lack of agreement in relation to perceived contraindications and safety of TBLB.

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Use of Spirometry to Predict Risk of Pneumothorax in CT-Guided Needle Biopsy of the Lung

Abstract: We conclude that decreasing FEV1 is associated with a higher pneumothorax rate.

Cited by 42 publications

References 14 publications

Ultrathin needle (25�G) aspiration lung biopsy: diagnostic accuracy and complication rates

Ultrathin needle (25�G) aspiration lung biopsy: diagnostic accuracy and complication rates

Pneumothorax Risk Factors in Smokers with and without Chronic Obstructive Pulmonary Disease

Contraindications and Safety of Transbronchial Lung Biopsy via Flexible Bronchoscopy

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