Variables affecting the risk of pneumothorax and intrapulmonal hemorrhage in CT-guided transthoracic biopsy

Abstract

The influence of various variables on the rate of pneumothorax and intrapulmonal hemorrhage associated with computed tomography (CT)-guided transthoracic needle biopsy of the lung were evaluated retrospectively. One hundred and thirty-three patients underwent CT guided biopsy of a pulmonary lesion. Two patients were biopsied twice. Variables analyzed were lesion size, lesion location, number of pleural needle passes, lesion margin, length of intrapulmonal biopsy path and puncture time. Eighteen-gauge (18G) cutting needles (Trucut, Somatex, Teltow, Germany) were used for biopsy. Pneumothorax occurred in 23 of 135 biopsies (17%). Chest tube placement was required in three out of 23 cases of pneumothorax (2% of all biopsies). Pneumothorax rate was significantly higher when the lesions were located in the lung parenchyma compared with locations at the pleura or chest wall (P < 0.05), but all pneumothorax cases which required chest tube treatment occurred in lesions located less than 2 cm from the pleura. Longer puncture time led to an increase in pneumothorax rate (P < 0.05). Thirty-seven (27%) out of 135 biopsies showed perifocal hemorrhage. Intrapulmonal biopsy paths longer than 4 cm showed significantly higher numbers of perifocal hemorrhage and pneumothorax (P < 0.05). Significantly more hemorrhage occurred when the pleura was penetrated twice during the puncture (P < 0.05). Lesion size <4 cm is strongly correlated with higher occurrence of perifocal hemorrhage (P < 0.05). Lesion margination showed no significant effect on complication rate. CT-guided biopsy of smaller lesions correlates with a higher bleeding rate. Puncture time should be minimized to reduce pneumothorax rate. Passing the pleura twice significantly increases the risk of hemorrhage. Intrapulmonal biopsy paths longer than 4 cm showed significantly higher numbers of perifocal hemorrhage as well as pneumothorax.

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

“…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.…”

“…The rate of pneumothorax in this study was 19% including the most minute cases, and the rate of chest tube insertion was only 2.9%. 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).…”

Factors affecting the accuracy and safety of computed tomography-guided biopsy of intrapulmonary solitary nodules ≤30 mm in a retrospective study of 155 patients

“…The most common complications of CT-guided percutaneous fine needle biopsy include pneumothorax and hemorrhage. The rate of pneumothorax ranges from 4 to 17% (7) in patients who receive CT-guided biopsy for large pulmonary lesions (mean diameter, 36 mm; range, 5-136 mm) (4,13). The rate of pneumothorax following CT-guided percutaneous core needle biopsy of small lesions (<20 mm in diameter) varies widely, ranging from 10 to 35% (8)(9)(10)14,15).…”

Utilidad de la biopsia percutánea core guiada por tomografía computada (TC) en lesiones pulmonares: experiencia de 7 años

“…No observamos complicaciones hemorrágicas mayores ni hemotórax. Potenciales factores descritos que inciden en la tasa de neumotórax son el diámetro y profundidad lesional 21,23 . En nuestra casuística los casos que presentaron neumotórax tuvieron una profundidad lesional promedio significativamente mayor que aquellos sin complicaciones (14 versus 7,5 mm).…”