Evaluation of various patient-, lesion-, and procedure-related factors on the occurrence of pneumothorax as a complication of CT-guided percutaneous transthoracic needle biopsy

Abstract

Purpose To assess the influence of various patient-, lesion-, and procedure-related variables on the occurrence of pneumothorax as a complication of CT-guided percutaneous transthoracic needle biopsy. Material and methods In a total of 208 patients, 215 lung/mediastinal lesions (seven patients were biopsied twice) were sampled under CT guidance using coaxial biopsy set via percutaneous transthoracic approach. Incidence of post procedure pneumothorax was seen and the influence of various patient-, lesion-, and procedure-related variables on the frequency of pneumothorax with special emphasis on procedural factors like dwell time and needle-pleural angle was analysed. Results Pneumothorax occurred in 25.12% (54/215) of patients. Increased incidence of pneumothorax had a statistically significant correlation with age of the patient ( p = 0.0020), size ( p = 0.0044) and depth ( p = 0.0001) of the lesion, and needle-pleural angle ( p = 0.0200). Gender of the patient ( p = 0.7761), emphysema ( p = 0.2724), site of the lesion ( p = 0.9320), needle gauge ( p = 0.7250), patient position ( p = 0.9839), and dwell time ( p = 0.9330) had no significant impact on the pneumothorax rate. Conclusions This study demonstrated a significant effect of the age of the patient, size and depth of the lesion, and needle-pleural angle on the incidence of post-procedural pneumothorax. Emphysema as such had no effect on pneumothorax rate, but once pneumothorax occurred, emphysematous patients were more likely to be symptomatic, necessitating chest tube placement. Gender of the patient, site of the lesion, patient position during the procedure, and dwell time had no statistically significant relation with the frequency of post-procedural pneumothorax. Surprisingly, needle gauge had no significant effect on pneumothorax frequency, but due to the small sample size, non-randomisation, and bias in needle size selection as per lesion size, further studies are required to fully elucidate the causal relationship between needle size and post-procedural pneumothorax rate. The needle should be as perpendicular as possible to the pleura (needle-pleural angle close to 90°), to minimise the possibility of pneumothorax after percutaneous transthoracic needle biopsy.

Impact of quantitative pulmonary emphysema score on the rate of pneumothorax and chest tube insertion in CT-guided lung biopsies

“…The only other factor that also had an impact on all three output parameters analysed in this study, that is instant pneumothorax, overall pneumothorax and chest tube insertion, was the lung parenchyma length punctured. This finding is in accordance with previously published data 21,24 .…”

“…Our analysis of n = 371 validates quantitatively determined pulmonary emphysema as a predictor of pneumothorax and is the first study to show that it is also a positive predictor of chest tube insertion for pneumothorax, which is contrary to the findings of the much smaller study of Lendeckel et al 15 . The rather large study population we analysed and the quantitative method we used to determine pulmonary emphysema make our findings more robust than published data obtained with qualitative methods as outlined in the Introduction section and which are inconsistent with respect to the effect of pulmonary emphysema on the occurrence of lung biopsy-related pneumothorax 21 .…”

“…A conventional CT scan of the region of interest was obtained prior to the intervention and was used to plan the best way to access the lesion. Basic principles observed for pathway planning as best as possible were choosing an angle perpendicular to the pleura, not crossing a lung fissure, avoiding large bronchi or blood vessels, minimising the length of the puncture pathway and passing at the upper edge of ribs in order to minimise the likelihood of costal nerve or vessel injury as recommended in the literature 20,21 .…”

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

“…This could be due to the difficulty of the patients to maintain the necessary apneas during the advancement of the coaxial needle and the introduction and removal of the cutting needle. Other groups [18,20,25] have also reported a higher frequency of pneumothorax in patients in this position, although their studies have not detected significant differences. A larger size of the nodule seems to correspond to a lower possibility of suffering this complication.…”

Incidence, severity and tolerability of pneumothorax following low‐dose CT‐guided lung biopsy in different severities of COPD

“…However, previous studies suggested that the probability of pneumothorax after biopsy was related to different factors, such as age, lesion size, depth and needle‐pleural angle, patients with COPD, pulmonary bullae, puncture after oblique fissure, more frequent puncture of pleura and less experienced surgeries. Shiekh et al reported that the presence of emphysema was not predictive of pneumothorax 11 . In contrast, Lendeckel et al demonstrated that emphysema was proportional to the incidence of pneumothorax after percutaneous lung biopsy 12 .…”