Risk factors of pneumothorax and chest tube placement after computed tomography-guided core needle biopsy of lung lesions: a single-centre experience with 822 biopsies

Abstract

PurposeTo determine the risk factors of pneumothorax and chest tube placement after computed tomography-guided core needle lung biopsy (CT-CNB).Material and methodsVariables that could increase the risk of pneumothorax and chest tube placement were retrospectively analysed in 822 CT-CNBs conducted with 18-gauge non-coaxial CT-CNB in 813 patients (646 men and 167 women; range: 18-90 years; mean: 59.8 years). Predictor variables were age, gender, patient position, severity of pulmonary emphysema, lesion size and localisation, contour characteristics, presence of atelectasis, pleural tag and fissure in the needle-tract, length of the aerated lung parenchyma crossed by the needle, needle entry angle, number of pleural punctures, experience of the operator, and procedure duration. All variables were investigated by ×2 test and logistic regression analysis.ResultsThe overall incidence of pneumothorax was 15.4% (127/822). Chest tube placement was required for 22.8% (29/127) of pneumothoraxes. The significant independent variables for pneumothorax were lesions smaller than 3 cm (p = 0.009), supine and lateral decubitus position during the procedure (p < 0.001), greater lesion depth (p = 0.001), severity of pulmonary emphysema (p < 0.001), needle path crossing the fissure (p < 0.001), and a path that skips the atelectasis (p < 0.001) or pleural tag (p < 0.001); those for chest tube placement were prone position (p < 0.001), less experienced operator (p = 0.001), severity of pulmonary emphysema (p < 0.001), and greater lesion depth (p = 0.008).ConclusionsThe supine and lateral decubitus position, a needle path that crosses the fissure, and a path that skips the atelectasis or a pleural tag are novel predictors for the development of pneumothorax.

Effect of Needle-Tract Bleeding on Pneumothorax and Chest Tube Placement Following CT Guided Core Needle Lung Biopsy

“…The records of the remaining 416 patients who underwent biopsies with a non-coaxial cutting needle (338 men and 78 women; age range, 18–89 years; average age, 59.3 years) were evaluated. The predictive variables of pneumothorax and chest tube placement after CT-CNB of our cohort were reported in a previous study [8].…”

“…Details of the biopsy procedure were described in a previous report [8]. The patients were placed in the supine, prone, or lateral positions, and CT scans were obtained to target the lesion.…”

Frequency of complications and risk factors associated with computed tomography guided core needle lung biopsies

“… 17 , 18 Choosing the shortest transpulmonary needle pathway may reduce the risk of both pneumothorax and alveolar hemorrhage. 15 , 17 , 26 …”

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

“…There are a number of studies investigating factors which might have an impact on the occurrence of pneumothorax and the need for chest tube insertion following lung biopsy with pulmonary emphysema being one of them [6][7][8][9][10][11][12] . In these studies, pulmonary emphysema was assessed visually, which is rather subjective and timeconsuming as the lung is a large organ covering many slices in a CT scan.…”

“…In order to include all relevant risk factors besides pulmonary emphysema the pertinent literature was thoroughly reviewed prior to data acquisition. The identified risk factors which were included into the analysis comprised needle size, puncture technique, lesion size, length of puncture tract in lung parenchyma, lung lobe harbouring the lesion, positioning of the patient during the procedure and level of experience of the interventionalist 7,8,17,18 .…”