Is emphysema a risk factor for pneumothorax in CT-guided lung biopsy?

Abstract

IntroductionComputed tomography (CT)-guided lung biopsy is commonly used to make a histological diagnosis for pulmonary lesions. Its most common complication is pneumothorax. While it is thought that CT-guided lung biopsy should be avoided in patients with emphysema, however, there is no scientific report documenting the relationship the occurrence of pneumothorax and the severity of emphysema.Purpose and methodsTo investigate the relationship between the severity of emphysema and the frequency of pneumothorax, we retrospectively reviewed all the patients who received CT-guided lung biopsy. Severity of emphysema is evaluated by Goddard classification, a visual scale by which areas of vascular disruption and low attenuation value were scored for each lung field of high resolution CT.Patients’ characteristics, prognostic accuracy of this method, size and location of the lesion, length of intrapulmonary biopsy paths, and frequency of complications such as pneumothorax or intrapulmonary hemorrhage were evaluated.ResultsOne hundred-two patients (69 males and 33 females) received 102 procedures. Diagnostic accuracy was 90.2%. Pneumothorax occurred in 41 of 102 biopsies (40.2%). Chest tube placement was required in 3 out of the 41 cases (7.3%) complicated by pneumothorax (2.9% of all the biopsies). The longer lesion depths from pleura were, the more frequently pneumothorax occurred (6.67 vs 3.66 mm, p=0.019). No correlation was found between location of lesions and frequency of pneumothorax. No significant differences of COPD staging or LAA score were seen between the patients with and without pneumothorax (5.73 vs 4.32 points, p=0.339).ConclusionWe suggest that severity of emphysema such as stage I or II COPD may not be related to the frequency of pneumothorax.

Logistic regression analysis and a risk prediction model of pneumothorax after CT-guided needle biopsy

“…The increased risk of pneumothorax from emphysema is primarily due to decreased lung elasticity and poor retraction of the lungs, which can easily cause a bulla followed by a pneumothorax. Lesions in contact with the pleura essentially have a depth of 0 cm, and previous studies found that the incidence of pneumothorax was higher when lesions were deeper with 1.0 or 2.0 cm used as cutoff points (15,16,30,(33)(34)(35); however, all of those studies included a depth of 0 cm in the analysis. In this study, we analyzed 607 lesions that had no contact with the pleura (depth ≠0 cm) and found that depth of the lesion was not a significant risk factor of pneumothorax.…”

“…Only Hiraki (15) thought that the size of the lesion did not correlate with the risk of pneumothorax, which is consistent with the findings of our study. Other researchers have thought that the incidence of pneumothorax was correlated with small lesion size (15,16,25,30,36). Because the accuracy of a biopsy is worse with smaller lesions, a higher number of pleural punctures may be required, which then increases the risk of pneumothorax.…”

“…Eight risk factors of pneumothorax were used for the univariate and multivariate analysis based on the literature (16,(26)(27)(28)(29)(30) and clinical experience as follows: (I) patient: age, sex, and history of emphysema; (II) lesion: size [shortaxis diameter: measured with a lung window width of 1,600 Hounsfield units (HU) and a window level of −600 HU], depth (the depth of normal lung tissue along the needle path and contact between the lesion and the pleura); (III) biopsy: body position (supine, prone, or lateral) and number of pleural punctures.…”

CT-guided biopsy of pulmonary nodules: is pulmonary hemorrhage a complication or an advantage?

“…Emphysema was considered mild for ≤25%, moderate for 25%-50%, and severe for >50% score. Only patients with moderate/severe score were deemed positive for emphysema (15).…”

Efficacy of an opposite position aspiration on resolution of pneumothorax following CT-guided lung biopsy

“…Pneumothorax is the most frequent complication of this technique. [1][2][3][4] Chest tube placement is associated with higher levels of pain and anxiety, and opioid pre-medication and local anaesthesia is required. 5 The infection risk and inpatient stay increased significantly.…”