Factors Influencing Pneumothorax Rate at Lung Biopsy: Are Dwell Time and Angle of Pleural Puncture Contributing Factors?

Ko, Jane P.; Shepard, Jo-Anne O.; Drucker, Elizabeth A.; Aquino, Suzanne L.; Sharma, Amita; Sabloff, Bradley S.; Halpern, Elkan F.; McLoud, Theresa C.

doi:10.1148/radiology.218.2.r01fe33491

Cited by 143 publications

(152 citation statements)

References 18 publications

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“…We defined the needle entry angle as the latter. Our results were in compliance with the previous studies (20,22,23). More than 45° of entry angle was a risk factor for pneumothorax causing a wider hole in the pleura if the needle crosses the pleura in an oblique fashion.…”

Section: Discussionsupporting

confidence: 92%

“…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). However, this topic is controversial because studies by Kuban et al (8) and Nour-Eldin et al (21) stated the contrary.…”

Section: Discussionmentioning

confidence: 82%

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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

Uzun

Akkaya²,

Atman³

et al. 2017

Diagn Interv Radiol

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CT-guided percutaneous transthoracic biopsy of the lung is a well-established method for diagnosis of pulmonary lesions yielding a diagnostic accuracy of 71%-95% (1-5), with pneumothorax being the most common complication varying between 17% and 26% (5-7). Currently coaxial technique is more commonly employed than the non-coaxial technique. The risk of pneumothorax may play a decisive role on this preference. Theoretically, fewer pleural passes means less risk of pneumothorax with the coaxial technique. However, introduction of relatively large bore needles are needed in the coaxial technique, which is a known risk factor for the development pneumothorax (8,9). To the best of our knowledge, there are only a few studies on CT-guided transthoracic fine needle aspiration (FNA) biopsies with non-coaxial technique on large patient populations (10, 11).The purpose of this retrospective study was to evaluate the diagnostic accuracy and safety of CT-guided transthoracic biopsy of pulmonary lesions with FNA using the non-coaxial technique. Methods PatientsThe institutional review board approved this retrospective study protocol and waived informed consent.CT images and biopsy records were retrospectively evaluated in 442 patients (346 males [78.3%] and 96 females [21.7%]; mean age, 64±10.8 years; range, 22-89 years) who underwent CT-guided transthoracic FNA of pulmonary lesions between July 2011 and June 2015. Bronchoscopy or transbronchial biopsies were nondiagnostic or not feasible in these patients.Exclusion criteria for the procedure were lesions <5 mm in maximum diameter, lesions suspected to be of vascular origin, uncorrectable coagulopathy (international normalized ratio ≥1.5, platelet count <50,000 K/UL), patients who were unable to maintain the appro- I N T E R V E N T I O N A L R A D I O LO G Y O R I G I N A L A R T I C L E PURPOSEWe aimed to evaluate the diagnostic accuracy and safety of computed tomography (CT)-guided biopsy of pulmonary lesions with fine needle aspiration (FNA) using non-coaxial technique. METHODSWe analyzed 442 patients who underwent CT-guided lung biopsy with FNA and non-coaxial technique to determine the diagnostic outcomes, complication rates, and independent risk factors for diagnostic failure and pneumothorax. RESULTSDiagnostic accuracy, sensitivity, and specificity were 97.6%, 97.3%, and 100%, respectively. Age and >35 mm lesion size were significant risk factors for diagnostic failure. The rates of pneumothorax and chest tube placement were 19% and 2.9%, respectively. Middle and lower lobe location, lesion to pleura distance >7.5 mm, and >45° needle trajectory angle were significant risk factors for pneumothorax. CONCLUSIONCT-guided FNA of pulmonary lesions with non-coaxial technique is a safe and reliable method with a relatively low pneumothorax rate and an acceptably high diagnostic accuracy.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 82%

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

Uzun

Akkaya²,

Atman³

et al. 2017

Diagn Interv Radiol

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“…The rate of complications requiring treatment is extremely low [19,20]. If the peripheral lesion can be visualized under ultrasound guidance, the accuracy increases to 75 % [25]. In a comparative study, cellular subtyping could be performed after transthoracic puncture in 86 % of patients and after transbronchial biopsy in only 61 % of patients [26].…”

mentioning

confidence: 99%

“…However, a minimally increased risk of pneumothorax seems acceptable if better diagnosis is achieved. A moderately longer duration of the needle in the lung parenchyma in the case of multiple biopsies does not appear to result in a significant increase in the risk of pneumothorax [25]. The use of a semiautomatic technique is useful in this connection.…”

mentioning

confidence: 99%

Complications in CT-Guided, Semi-Automatic Coaxial Core Biopsy of Potentially Malignant Pulmonary Lesions

Schulze

Seebacher

Enderes

et al. 2015

Fortschr Röntgenstr

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Purpose: Histological verification of pulmonary lesions is important to ensure correct treatment. Computed tomographic (CT) transthoracic core biopsy is a well-established procedure for this. Comparison of available studies is difficult though, as technical and patient characteristics vary. Using a standardized biopsy technique, we evaluated our results for CT-guided coaxial core biopsy in a semi-automatic technique. Materials and Methods: Within 2 years, 664 consecutive transpulmonary biopsies were analyzed retrospectively. All interventions were performed using a 17/18G semi-automatic core biopsy system (4 to 8 specimens). The incidence of complications and technical and patient-dependent risk factors were evaluated. Results: Comparing the histology with the final diagnosis, the sensitivity was 96.3?%, and the specificity was 100?%. 24 procedures were not diagnostic. In all others immunohistological staining was possible. The main complication was pneumothorax (PT, 21.7?%), with chest tube insertion in 6?% of the procedures (n?=?40). Bleeding without therapeutic consequences was seen in 43 patients. There was no patient mortality. The rate of PT with chest tube insertion was 9.6?% in emphysema patients and 2.8?% without emphysema (p?=?0.001). Smokers with emphysema had a 5 times higher risk of developing PT (p?=?0.001). Correlation of tumor size or biopsy angle and the risk of PT was not significant. The risk of developing a PT was associated with an increasing intrapulmonary depth of the lesion (p?=?0.001). Conclusion: CT-guided, semiautomatic coaxial core biopsy of the lung is a safe diagnostic procedure. The rate of major complications is low, and the sensitivity and specificity of the procedure are high. Smokers with emphysema are at a significantly higher risk of developing pneumothorax and should be monitored accordingly. Key points: ??Using an 18G core biopsy system with 6 specimens will allow immunohistological staining with high sensitivity and specificity. ??Smokers with emphysema are at a significantly higher risk of developing a pneumothorax. Citation Format: ??Schulze R, Seebacher G, Enderes B. et?al. Complications in CT-Guided, Semi-Automatic Coaxial Core Biopsy of Potentially Malignant Pulmonary Lesions. Fortschr R?ntgenstr 2015; 187: 697???702

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“…The presence of COPD may be a risk factor [14•, 16, 17] as well as a smaller needlepleural angle when taking the biopsy [18,19]. Some studies suggest that the deeper the lesion being biopsied, the higher the risk of pneumothorax [17,19], but this finding is not consistent across all studies [18,20].…”

Section: Iatrogenic Pneumothoraxmentioning

confidence: 99%

Common iatrogenic pleural complications

Dunscombe

Maskell

2012

Curr Respir Care Rep

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All invasive pleural procedures have the potential to cause harm. Complications from pleural procedures include empyema, intercostal artery laceration, hemothorax, and pneumothorax as well as other organ puncture. Many of these complications will be life threatening and will increase morbidity and hospital length of stay. An understanding of iatrogenic pleural disease helps clinicians to appreciate how these risks can be minimized and complications managed promptly and effectively. This review systematically evaluates the current evidence and guidelines regarding iatrogenic pleural complications and their management. Whilst impossible to eliminate procedural risk entirely, complications will be reduced to a minimum by ensuring adequate medical training, use of pleural ultrasound, and adherence to guidelines and standard operating procedures (SOPs).

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Factors Influencing Pneumothorax Rate at Lung Biopsy: Are Dwell Time and Angle of Pleural Puncture Contributing Factors?

Abstract: Longer dwell times do not correlate with pneumothorax and should not influence the decision to obtain more biopsy samples. A shallow pleural puncture angle may increase the pneumothorax rate.

Cited by 143 publications

References 18 publications

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

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

Complications in CT-Guided, Semi-Automatic Coaxial Core Biopsy of Potentially Malignant Pulmonary Lesions

Common iatrogenic pleural complications

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