Does biopsy needle traversing through central portion of lesion increase the risk of hemoptysis during percutaneous transthoracic needle biopsy?

Chen, Chia-Hung; Huang, Wei‐Ming; Liang, Shih-Hsuan; Jhou, Zong-Yi; Chen, Chien-Wen; Chien, Yu-Chan; Lin, Hui-Chen; Wang, Chih-Hsin; Huang, Chun-Chao; Liao, Wei-Ni

doi:10.1007/s11604-018-0719-2

Cited by 9 publications

(9 citation statements)

References 19 publications

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“…We also detected that the deepest location of the lesion was a risk factor for bleeding (p = 0.045), which can be explained in a similar way to that of pneumothorax because a long path of the needle has a greater chance of going through vascular structures. Several groups [18][19][20]22,24,28] have found similar findings in their observations. In our case, hemoptysis episodes were self-limiting and without clinical repercussions.…”

Section: Discussionsupporting

confidence: 71%

Cone-Beam CT-Guided Lung Biopsies: Results in 94 Patients

et al. 2020

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Background: The aim of this study was to evaluate the diagnostic capacity of Cone-Beam computed tomography (CT)-guided transthoracic percutaneous biopsies on lung lesions in our setting and to detect risk factors for possible complications. Methods: Retrospective study of 98 biopsies in 94 patients, performed between May 2017 and January 2020. To obtain them, a 17G coaxial puncture system and a Siemens Artis Zee Floor vc21 archwire were used. Descriptive data of the patients, their position at the time of puncture, location and size of the lesions, number of cylinders extracted, and complications were recorded. Additionally, the fluoroscopy time used in each case, the doses/area and the estimated total doses received by the patients were recorded. Results: Technical success was 96.8%. A total of 87 (92.5%) malignant lesions and 3 (3.1%) benign lesions were diagnosed. The sensitivity was 91.5% and the specificity was 100%. We registered three technical failures and three false negatives initially. Complications included 38 (38.8%) pneumothorax and 2 (2%) hemoptysis cases. Fluoroscopy time used in each case was 4.99 min and the product of the dose area is 11,722.4 microGy/m2. Conclusion: The transthoracic biopsy performed with Cone-Beam CT is accurate and safe in expert hands for the diagnosis of lung lesions. Complications are rare and the radiation dose used was not excessive.

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Section: Discussionsupporting

confidence: 71%

Cone-Beam CT-Guided Lung Biopsies: Results in 94 Patients

et al. 2020

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“…Based on clinical experience and a literature review, we estimated that the risk scoring system for pneumothorax achieved a 70% sensitivity and a 90% speci city. The average prevalence of pneumothorax was approximately 15% in previous studies (2,4,12) . We chose α = 0.05 and maximum marginal error of estimate = 5%.…”

Section: Discussionmentioning

confidence: 87%

Development And Validation of a Risk Scoring System to Predict Pneumothorax in CT-Guided Percutaneous Transthoracic Needle Biopsy

Yang

Luo

Peng

et al. 2021

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Objective: To develop and validate a risk scoring system using variables easily obtained for the prediction of pneumothorax in CT-guided percutaneous transthoracic needle biopsy (PTNB).Methods: The derivation cohort was comprised of 1001 patients who underwent CT-guided PTNB. Multivariate logistic regression was used to identify risk factors for pneumothorax, which were treated as the foundation to develop the risk scoring system. To validate the system, a validation cohort group of 230 patients was enrolled.Results: Age, puncture times, puncture depth, smoking index, number of specimens, bleeding from the needle path, and lobular lesion were identified as risk factors in the derivation cohort. A risk scoring system (Hosmer-Lemeshow goodness-of-fit test p =0.33) was developed. The area under the receiver operating characteristic curve (AUROC) was 0.601 by using the risk score system. This risk score system demonstrated a better diagnostic effect with increasing age. In the group of patients older than 80 years, the AUROC was 0.76, showing good predictive power. This risk scoring system was confirmed in the validation cohort with an AUROC of 0.736.Conclusion: This scoring system has a good predictive effect in both derivation and validation cohort.

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“…Severe pulmonary hemorrhage, hemoptysis, or hemothorax occur in < 0.1% of cases . The identified potential risk factors of postprocedural pulmonary hemorrhage include subsolid lesion patterns, small lesion size, greater lesion depth or long biopsy path, emphysema, and pulmonary arterial hypertension . The use of anticoagulant medication or a bleeding diathesis is contraindicated for this procedure.…”

Section: Introductionmentioning

confidence: 99%

“…Computed tomography (CT)-guided percutaneous needle biopsy has been commonly performed for many years because of the high diagnostic accuracy and low complication rate. 1 The most common complications are pneumothorax and pulmonary hemorrhage. Other less common complications include air embolism and pleural or chest wall tumor seeding.…”

Section: Introductionmentioning

confidence: 99%

“…2,3 The identified potential risk factors of postprocedural pulmonary hemorrhage include subsolid lesion patterns, small lesion size, greater lesion depth or long biopsy path, emphysema, and pulmonary arterial hypertension. 1,[4][5][6][7] The use of anticoagulant medication or a bleeding diathesis is contraindicated for this procedure. Injury to systemic arteries or central vessels should be avoided.…”

Section: Introductionmentioning

confidence: 99%

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Massive hemothorax after computed tomography‐guided lung tumor biopsy: An unusual but disastrous complication

et al. 2018

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Intercostal artery injury during transthoracic puncture is rare but is accompanied by high rates of morbidity and mortality. We report a case with metachronous double primary esophageal cancers and development of multiple lung nodules. Tissue proof for the lung nodules is required to guide the following treatment protocol. Our patient died soon after computed tomography‐guided lung tumor biopsy was performed, as a result of procedure‐related massive and uncontrolled hemothorax. The cause is likely intercostal artery injury related to the transthoracic puncture. After review of our case and the wide variation in intercostal artery courses, we identify several considerations that should be included in procedural planning to further decrease the risk of intercostal artery injury during transthoracic puncture, including avoiding choosing target lesions at the posterior lung, keeping the puncture needle as close to the superior rib margin as possible, and checking the density of new pleural fluid. In addition, it is important to inform clinical doctors when the risk of periprocedural vascular injury is high.

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Does biopsy needle traversing through central portion of lesion increase the risk of hemoptysis during percutaneous transthoracic needle biopsy?

Abstract: Traversal through the central part of the lesion by the biopsy needle is not a risk factor of PTNB-related hemoptysis, but subsolid lesions and lesion depth > 1 cm increase the risk of hemoptysis.

Cited by 9 publications

References 19 publications

Cone-Beam CT-Guided Lung Biopsies: Results in 94 Patients

Cone-Beam CT-Guided Lung Biopsies: Results in 94 Patients

Development And Validation of a Risk Scoring System to Predict Pneumothorax in CT-Guided Percutaneous Transthoracic Needle Biopsy

Massive hemothorax after computed tomography‐guided lung tumor biopsy: An unusual but disastrous complication

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