Development and validation of a prediction model of pneumothorax after CT-guided coaxial core needle lung biopsy

Abstract

Background: Pneumothorax is the most common complication of computed tomography-guided coaxial core needle biopsy (CCNB) and may be life-threatening. We aimed to evaluate the risk factors and develop a model for predicting pneumothorax in patients undergoing computed tomography-guided CCNB, and to further determine its clinical utility. Methods: Univariate and multivariate logistic regression analyses were conducted to identify independent risk factors for pneumothorax from 18 variables. A predictive model was established using multivariable logistic regression and presented as a nomogram based on a training cohort of 690 patients who underwent computed tomography-guided CCNB. The model was validated in 253 consecutive patients in the validation cohort and 250 patients in the test cohort. The area under the curve was used to determine the predictive accuracy of the proposed model. Results: The risk factors associated with pneumothorax after computed tomography-guided CCNB were sex, patient position, lung field, lesion contact with the pleura, lesion size, distance from the pleura to the lesion, presence of emphysema adjacent to the biopsy tract, and crossing fissures. The predictive model that incorporated these predictors showed good predictive performance in the training cohort [area under the curve, 0.71 (95% confidence interval: 0.67-0.75)], validation cohort [0.71 (0.64-0.78)], and internal test cohort [0.68 (0.60-0.75)]. The nomogram also provided excellent calibration and discrimination, and decision curve analysis (DCA) demonstrated its clinical utility.Conclusions: The predictive model showed good performance for pneumothorax after computed tomography-guided CCNB and may help improve individualized preoperative prediction.

Score to Predict the Occurrence of Pneumothorax After Computed Tomography-guided Percutaneous Transthoracic Lung Biopsy

“…Emphysema, absence of contact between lesion and pleura, and prone or lateral position were associated with an increased risk of pneumothorax. Again Zhao et al recently developed a predictive score similar to ours, which appears less efficient (AUC= 0.71) with an increased number of factors to assess (9) 19 …”

“…The prediction score of PTLB complications is currently trending. [14][15][16][17][18][19][20] Both the retrospective studies by Anzidei et al and Iezzi et al presented a score predicting the occurrence of several complications, including pneumothorax. 14,15 Yang et al recently presented a predictive score for pneumothorax after a CT-guided co-axial core needle lung biopsy.…”

“…Again Zhao et al recently developed a predictive score similar to ours, which appears less efficient (AUC = 0.71) with an increased number of factors to assess (9). 19 Among the variables included in our score, the biopsy approach is a debated risk factor for pneumothorax in the literature. We showed that an anterior approach was associated with a higher risk of pneumothorax.…”

“…The prediction score of PTLB complications is currently trending 14–20 . Both the retrospective studies by Anzidei et al and Iezzi et al presented a score predicting the occurrence of several complications, including pneumothorax 14,15 .…”

Presurgical computed tomography-directed identification of lung ground-glass nodules: comparing between hook-wire and indocyanine green

“…This indicates that hook-wire usage may trigger pneumothorax development. Non-upper lobe lesion is another risk factor for pneumothorax, and this nding may be due to the fact that, relative to the upper lung elds, the lower lung eld participates in more respiratory motion [22].…”