Tract sealing with normal saline after percutaneous transthoracic lung biopsies

Abstract

Introduction: In the present study, we aimed to assess whether normal saline injection for sealing the biopsy track is useful in reducing the incidence of pneumothorax after computed tomography (CT)-guided percutaneous transthoracic lung biopsy (PTLB). Methods: We retrospectively compared the incidence of pneumothorax in 100 consecutive biopsies (n = 100, group A) that had injection of saline along the track, with historical cohort of same number of consecutive patients who underwent PTLB without injection of saline along the needle track (n = 100, group B). CT-guided biopsies were performed by coaxial technique and 1-3 ml of saline was injected along the tract. Patient characteristics, lesion size, location and other baseline parameters were compared. Incidence of pneumothorax and number of patients who underwent catheter drainage of pneumothorax was compared in both groups. Results: Baseline characteristics were comparable in both groups. Track sealing with saline was successful in all patients. Pneumothorax rate was 46% for patients in group B and 32% in group A (P < 0.05). Seven patients (7%) had insertion of chest drain for pneumothorax in the group B and only 1% in the group A (P < 0.05). No mortality was observed in both groups. No complications were observed in any of the patients due to saline injection. Conclusion: Track sealing with saline is a simple and safe technique which significantly reduces the incidence of pneumothorax and chest tube insertion after PTLB.

Tract sealing with normal saline after percutaneous transthoracic lung biopsies – promising but better evidence required

“…The authors are to be commended for a study comparable in size to previous studies examining the use of normal saline tract sealing after lung biopsies by Billich et al (2008) and Li et al (2015) 2,3 . Babu and colleagues demonstrated that compared with control, patients who received normal saline tract sealing had a significantly lower rate of pneumothorax (32% vs. 46%, P = 0.04) and drainage of pneumothoraxes (1% vs. 7%, P = 0.03) 1 . These findings are consistent, albeit more modest, compared with a recently published meta‐analysis that demonstrated normal saline tract sealant reduced the risk of pneumothorax by sixfold (pooled incidence 6.9% vs. 28.6%, OR 0.18, P < 0.001) and chest drain insertion by approximately ninefold (pooled incidence: 0.8% vs. 7.3%, pooled OR 0.11) 4 …”

“…We read with interest the recent article by Babu and colleagues 'Tract sealing with normal saline after percutaneous transthoracic lung biopsies'. 1 This retrospective study adds to recent literature in reducing pneumothorax rates during lung biopsies.…”

“…Our systematic review and meta‐analysis demonstrated there are a number of modifiable and non‐modifiable risk factors for a pneumothorax, some of which have not been discussed or controlled for in the study by Babu and colleagues (2020), 1,4 for example whether the procedure was done with biopsied lung ante‐dependent (puncture site up) (although this is suggested by the figure). A recent study demonstrated a reduction in pneumothorax rates if the biopsied lung was dependent 5 .…”

“…4 As Babu and colleagues discussed, use of normal saline is one of the multiple substances that have been used to seal the needle tract after lung biopsies. 1 Alternative tract plug materials include hydrogel plug, compressed collagen foam plugs, fibrin glue, absorbable haemostat gelatine powder and autologous blood patches. In general terms, all of these techniques have demonstrated to reduce rates of pneumothorax.…”

Transthoracic Needle Biopsy: How to Maximize Diagnostic Accuracy and Minimize Complications

“…[42][43][44] In addition to these materials, track sealing with saline is also effective to reduce the incidence and chest tube insertion. 45 In another study, saline sealing did not reduce the incidence, but significantly reduced pneumothorax size and chest tube replacement. 46…”