Lobar location of lesions in computed tomography-guided lung biopsy is correlated with major pneumothorax

Abstract

Pneumothorax is a common complication in computed tomography (CT)-guided percutaneous lung biopsy (CPLB). Whether the lobar location of lesions contributes to the incidence of pneumothorax should be further clarified. A total of 1452 consecutive patients who underwent CPLB between January 2010 and March 2018 were retrospectively analyzed. The incidence of pneumothorax was compared among 5 different lobe biopsies. Minor pneumothorax was defined as pneumothorax without chest tube placement and major pneumothorax was defined as pneumothorax with chest tube placement. The positive diagnosis rate of pathology for this cohort was approximately 84%, with 22.5% (326/1452) of the patients experiencing pneumothorax. The rates of pneumothorax were 19.5%, 24.5%, 33.9%, 21.4%, and 23.9% for the right upper lobe, right lower lobe, right middle lobe, left upper lobe, and left lower lobe, respectively ( P = .09). Chest tube placement was necessary in 19.0% (62/326) of the patients with pneumothorax. The rates of major pneumothorax were 5.3%, 2.6%, 10.2%, 4.7%, and 2.6% for the right upper lobe, right lower lobe, right middle lobe, left upper lobe, and left lower lobe biopsies, respectively ( P = .02). This result was further confirmed by the propensity score-matching method. Moreover, 8.7% (127/1452) of the patients experienced puncture of fissure, the rates of which were 13.5%, 5%, 10.2%, 9.1%, and 4.3% for the right upper lobe, right lower lobe, right middle lobe, left upper lobe, and left lower lobe, respectively ( P < .001). Within the pneumothorax patient group, the rate of lobe fissure puncture (15.2%) was significantly lower in patients with minor pneumothorax than (51.6%) in those with major pneumothorax ( P < .001). Upper and middle lobe lesion biopsies show a significantly high rate of major pneumothorax, which may be due to more puncture of fissure. It is crucial to carefully distinguish the fissure around lesions and bypass it to avoid major pneumothorax.

A Non-invasive Method to Diagnose Lung Adenocarcinoma

“…The histological type diagnosis of lung cancer is fundamental in guiding patient management. Lung biopsy is a well-established method for the differential diagnosis of lung lesions (7), but it is expensive and invasive. Lung Adenocarcinoma (Adc) is the most common subtype of lung cancer (8), and diagnosing Adc by biopsy is not beneficial to the patients unfit for the invasive diagnostic procedure.…”

Comparison of CT-Guided Core Needle Biopsy in Pulmonary Ground-Glass and Solid Nodules Based on Propensity Score Matching Analysis

“… 20 Previous literature indicated that when the targeted lesion located in the upper or middle lobe, major pneumothorax rate was often higher due to more punctures through fissure. 21 Hence, the operators should avoid traversing fissure as far as possible.…”

Complicaciones de la biopsia percutánea de pulmón guiada por tomografía

“…Al analizar la ocurrencia de complicaciones respecto a la localización de las lesiones, se encontró que 7 de 17 pacientes con complicaciones (41,2 %) tenían la lesión en el lóbulo inferior derecho, lo que es coherente con estudios previos en los cuales se ha informado que las lesiones en el lóbulo inferior derecho y en el lóbulo medio presentan mayores tasas de complicación, con el neumotórax como la más frecuente (27).…”