Efficacy of a Self-expanding Tract Sealant Device in the Reduction of Pneumothorax and Chest Tube Placement Rates After Percutaneous Lung Biopsy: A Matched Controlled Study Using Propensity Score Analysis

Ahrar, Judy; Gupta, Sanjay; Ensor, Joe; Mahvash, Armeen; Sabir, S.; Steele, Joseph R.; McRae, Stephen E.; Avritscher, Rony; Huang, Steven Y.; Odisio, Bruno C.; Murthy, Ravi; Ahrar, Kamran; Wallace, Michael J.; Tam, Alda L.

doi:10.1007/s00270-016-1489-9

Cited by 40 publications

(24 citation statements)

References 29 publications

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“…However, disadvantages with these materials are local tissue reaction, inflammation and scarring. A recent randomized trial of use of a hydrogel plug has been published . This has been recently approved by US Food and Drug Administration (USFDA) and currently available as BioSentry TM (Surgical Specialties Corporation, Wyomissing, PA, USA).…”

Section: Discussionmentioning

confidence: 99%

Tract sealing with normal saline after percutaneous transthoracic lung biopsies

et al. 2020

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Introduction: In the present study, we aimed to assess whether normal saline injection for sealing the biopsy track is useful in reducing the incidence of pneumothorax after computed tomography (CT)-guided percutaneous transthoracic lung biopsy (PTLB). Methods: We retrospectively compared the incidence of pneumothorax in 100 consecutive biopsies (n = 100, group A) that had injection of saline along the track, with historical cohort of same number of consecutive patients who underwent PTLB without injection of saline along the needle track (n = 100, group B). CT-guided biopsies were performed by coaxial technique and 1-3 ml of saline was injected along the tract. Patient characteristics, lesion size, location and other baseline parameters were compared. Incidence of pneumothorax and number of patients who underwent catheter drainage of pneumothorax was compared in both groups. Results: Baseline characteristics were comparable in both groups. Track sealing with saline was successful in all patients. Pneumothorax rate was 46% for patients in group B and 32% in group A (P < 0.05). Seven patients (7%) had insertion of chest drain for pneumothorax in the group B and only 1% in the group A (P < 0.05). No mortality was observed in both groups. No complications were observed in any of the patients due to saline injection. Conclusion: Track sealing with saline is a simple and safe technique which significantly reduces the incidence of pneumothorax and chest tube insertion after PTLB.

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Section: Discussionmentioning

confidence: 99%

Tract sealing with normal saline after percutaneous transthoracic lung biopsies

et al. 2020

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“…Computed tomography (CT)-guided core needle lung biopsy (CT-CNB) is a reliable and safe diagnostic procedure; the most common complication of CT-CNB is pneumothorax [12]. Some invasive techniques, such as injection of sealant materials (e.g., autologous blood patch, collagen plugs, fibrin glue, normal saline, hydrogel plugs) into the biopsy tract have been studied for their ability to decrease the risk of pneumothorax [345]. The use of an autologous blood patch is perhaps the most widely known technique, but it has shown varying results [6].…”

Section: Introductionmentioning

confidence: 99%

Effect of Needle-Tract Bleeding on Pneumothorax and Chest Tube Placement Following CT Guided Core Needle Lung Biopsy

Soylu

Öztürk

Gökalp

et al. 2019

Journal of the Belgian Society of Radiology

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Background: Bleeding in the biopsy tract has been studied for its ability to decrease the risk of pneumothorax with indefinite results in the previous studies. Purpose: To investigate the risk factors for needle-tract bleeding (NTB) and the possible effect of NTB on the pneumothorax and resultant chest tube placement after CT-guided cutting needle biopsy (CT-CNB) of pulmonary lesions. Methods: Predictive variables for NTB and the effect of NTB on the development of pneumothorax and consequent chest tube placement were retrospectively determined in 416 patients who had undergone an 18-gauge non-coaxial CT-CNB (338 men and 78 women; average age, 59.3 years). Patient-related parameters were age, gender, patient position, and severity of pulmonary emphysema. Lesion-related variables were size, localization, and contour characteristics of the lesion. Procedure-related variables were the presence of atelectasis, pleural tag, and fissure in the needle-tract, length of the aerated lung parenchyma crossed by needle, needle entry angle, number of pleural punctures, the experience of the operator, and procedure duration. All variables were analyzed by x 2 test and logistic regression analysis. Results: NTB was demonstrated in 142 of 421 (33.7%) procedures. The predictive variables of NTB were smaller lesion size (p = 0.011) and greater lesion depth (p = 0.002). In patients without emphysema around the lesion, the pneumothorax developed in 44/190 cases (23.1%) without NTB and in 12/95 procedures (12.6%) with NTB (p < 0.001). Conclusion: NTB may have a preventive effect on pneumothorax development, particularly in the absence of emphysema around the lesion.

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“…In this study, transthoracic needle biopsies were performed using the BioSentry Tract Sealant System because its efficacy in reducing the number of biopsy-related pneumothoraces and chest-tube placements has been validated in other trials. 16 , 19 Although the injected plug is 2.5 cm in length and is deposited peripherally, this study shows that the injection of the hydrogel plug commonly results in a visible and persistent tract within the lung parenchyma that can mimic tumor cell dissemination along the biopsy needle tract.…”

Section: Discussionmentioning

confidence: 80%

“…In this newer transthoracic biopsy technique, a hydrogel plug is injected while withdrawing the needle at the completion of the biopsy procedure to decrease the incidence of pneumothoraces, the most common complication of transthoracic lung biopsy. 16 , 17 , 18 The resulting biopsy tract can be visible within the lung parenchyma on follow-up chest computed tomography (CT) and/or 18 fluorodeoxyglucose (FDG) positron emission tomography (PET) CT imaging and can potentially mimic malignant tract seeding. This could result in a larger gross tumor volume (GTV) and planning target volume (PTV) or larger limited resection in those patients undergoing wedge resection.…”

Section: Introductionmentioning

confidence: 99%

Implications for high-precision dose radiation therapy planning or limited surgical resection after percutaneous computed tomography-guided lung nodule biopsy using a tract sealant

Groot¹,

Shroff²,

Ahrar³

et al. 2018

Advances in Radiation Oncology

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PurposePrecision radiation therapy such as stereotactic body radiation therapy and limited resection are being used more frequently to treat intrathoracic malignancies. Effective local control requires precise radiation target delineation or complete resection. Lung biopsy tracts (LBT) on computed tomography (CT) scans after the use of tract sealants can mimic malignant tract seeding (MTS) and it is unclear whether these LBTs should be included in the calculated tumor volume or resected. This study evaluates the incidence, appearance, evolution, and malignant seeding of LBTs.Methods and materialsA total of 406 lung biopsies were performed in oncology patients using a tract sealant over 19 months. Of these patients, 326 had follow-up CT scans and were included in the study group. Four thoracic radiologists retrospectively analyzed the imaging, and a pathologist examined 10 resected LBTs.ResultsA total of 234 of 326 biopsies (72%, including primary lung cancer [n = 98]; metastases [n = 81]; benign [n = 50]; and nondiagnostic [n = 5]) showed an LBT on CT. LBTs were identified on imaging 0 to 3 months after biopsy. LBTs were typically straight or serpiginous with a thickness of 2 to 5 mm. Most LBTs were unchanged (92%) or decreased (6.3%) over time. An increase in LBT thickness/nodularity that was suspicious for MTS occurred in 4 of 234 biopsies (1.7%). MTS only occurred after biopsy of metastases from extrathoracic malignancies, and none occurred in patients with lung cancer.ConclusionsLBTs are common on CT after lung biopsy using a tract sealant. MTS is uncommon and only occurred in patients with extrathoracic malignancies. No MTS was found in patients with primary lung cancer. Accordingly, potential alteration in planned therapy should be considered only in patients with LBTs and extrathoracic malignancies being considered for stereotactic body radiation therapy or wedge resection.

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Efficacy of a Self-expanding Tract Sealant Device in the Reduction of Pneumothorax and Chest Tube Placement Rates After Percutaneous Lung Biopsy: A Matched Controlled Study Using Propensity Score Analysis

Cited by 40 publications

References 29 publications

Tract sealing with normal saline after percutaneous transthoracic lung biopsies

Tract sealing with normal saline after percutaneous transthoracic lung biopsies

Effect of Needle-Tract Bleeding on Pneumothorax and Chest Tube Placement Following CT Guided Core Needle Lung Biopsy

Implications for high-precision dose radiation therapy planning or limited surgical resection after percutaneous computed tomography-guided lung nodule biopsy using a tract sealant

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