Pneumothorax Rate and Diagnostic Adequacy of Computed Tomography–guided Lung Nodule Biopsies Performed With 18 G Versus 20 G Needles

Abstract

Purpose: Conflicting data exist with regard to the effect of needle gauge on outcomes of computed tomography (CT)-guided lung nodule biopsies. The purpose of this study was to compare the complication and diagnostic adequacy rates between 2 needle sizes: 18 G and 20 G in CT-guided lung nodule biopsies. Materials and Methods: This retrospective cohort study examined CT-guided lung biopsies performed between March 2014 and August 2016 with a total of 550 patients between the ages of 30 and 94. Biopsies were performed using an 18-G or a 20-G needle. Procedure-associated pneumothorax and other complication rates were compared between the 2 groups. Univariate and multiple logistic regression analyses were performed. Results: There was no significant difference in pneumothorax rate between 18 G (n=125) versus 20 G (n=425) (rates: 25.6% vs. 28.7%; P=0.50; odds ratio [OR]=0.86; 95% confidence interval [CI]=0.54-1.35), chest tube insertion rate (4.8% vs. 5.6%; P=0.71; OR=0.84; 95% CI=0.34-2.11), or diagnostic adequacy (95% vs. 93%; P=0.36; OR=1.51; 95% CI=0.61-3.72). Multiple logistic regression analysis demonstrated emphysema along the biopsy path (OR=3.12; 95% CI=1.63-5.98) and nodule distance from the pleural surface ≥4 cm (OR=1.85; 95% CI=1.05-3.28) to be independent risk factors for pneumothorax. Conclusion: No statistically significant difference in pneumothorax rate or diagnostic adequacy was found between 18-G versus 20-G core biopsy needles. Independent risk factors for pneumothorax include emphysema along the biopsy path and nodule distance from the pleural surface.

Ultrasound- Versus CT-Guided Subpleural Lung and Pleural Biopsy: An Analysis of Wait Times, Procedure Time, Safety, and Diagnostic Adequacy

“…6,8 However, in a retrospective review of 550 CT-guided lung biopsies comparing 18- and 20-gauge core biopsies, there was no significant difference in sample adequacy (95% and 93%, respectively). 21…”

“…6,8 However, in a retrospective review of 550 CT-guided lung biopsies comparing 18-and 20-gauge core biopsies, there was no significant difference in sample adequacy (95% and 93%, respectively). 21 Pneumothorax is well-established as the leading complication of PTNB. However, the reported incidence is widely variable.…”

Pneumothorax after CT-guided transthoracic lung biopsy: A comparison between immediate and delayed occurrence

“…Risk factors for pneumothorax after transthoracic lung biopsy have been examined widely. Among the known risk factors, some are consistent whereas others are inconsistent or even contradictory across published studies, probably owing to various baseline characteristics, biopsy techniques, and analytic methods [8][9][10][11][12]. Although biopsy related pneumothorax frequently occurs during or immediately after procedure, pneumothorax can be identified in the follow-up chest radiographs or even after discharge due to chest pain or dyspnea (delayed pneumothorax) [13,14].…”

Percutaneous Transthoracic Lung Biopsy: Optimizing Yield and Mitigating Risk

“…Positive pressure ventilation and intractable cough are thought to confer a greater risk of systemic air embolism (SAE) and pneumothorax. 8,9 Patients with severe emphysema or interstitial lung disease, and oxygen-dependent patients are also at increased risk of pneumothorax, particularly if the needle trajectory necessitates traversing areas of emphysema [10][11][12] or fibrosis, including blebs, bullae, and honeycombing. Even so, patients with fibrosis, particularly those being assessed for potential lung transplant and with indeterminate nodules, may proceed to PTLB (Fig.…”

“…67 A number of factors have been suggested to increase pneumothorax rates. These include patient factors, such as age, 12,68 emphysema, 12,22,48,67 smoking history, 68 and supine 22,68 and lateral decubitus positions 22,67 ; lesion factors, such as small lesion size, 16,[47][48][49]58,67,68 lesion depth, 11,12,[48][49][50]67,68 and subpleural location 47 ; and technique-related factors, such as anterior approach, 67 wider pleural angle, 49 needle gauge or type, 48,67 number of pleural punctures, 12,67,69 and breaching of fissures. 12,22,48,67 A metaanalysis by Huo et al 67 found the highest rate of pneumothorax when traversing bullae or fissures and for patients in the lateral decubitus position (biopsied lung nondependent).…”