Pneumothorax After CT-guided Transthoracic Lung Biopsy: A Comparison Between Immediate and Delayed Occurrence

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2020 Aug 25

PMID 32834016

Citations 10

Authors

Kyungsoo Bae

Ji Young Ha

Kyung Nyeo Jeon

Affiliations

Soon will be listed here.

Abstract

Background: In CT-guided transthoracic lung biopsy (CTLB), pneumothorax can occur as a late complication (delayed pneumothorax). The incidence, risk factors, and clinical significance of delayed pneumothorax are not well known.

Objectives: To compare the risk factors for immediate and delayed pneumothorax after CTLB and to know their clinical significance.

Methods: Images and medical records of 536 consecutive patients who underwent CTLB were reviewed. All biopsies were performed as inpatient procedures. Follow-up chest radiographs were obtained at least twice at 4 h after procedure and before discharge. Risk factors for immediate and delayed pneumothorax were assessed based on patient-, lesion-, and procedure-related variables. Rates of chest tube insertion were also compared.

Results: Pneumothorax developed in 161 patients (30.0%) including 135 (25.2%) immediate and 26 (4.9%) delayed cases. Lesion size was an independent risk factor for both immediate and delayed pneumothorax (OR = 0.813; CI = 0.717-0.922 and OR = 0.610; CI = 0.441-0.844, respectively). While emphysema, lower lobe location, and long intrapulmonary biopsy track were risk factors (OR = 1.981; CI = 1.172-3.344, OR = 3.505; CI = 2.718-5.650, and OR = 1.330; CI = 1.132-1.563, respectively) for immediate pneumothorax, upper lobe location and increased number of pleural punctures were independent risk factors (OR = 5.756; CI = 1.634-20.274 and OR = 3.738; CI = 1.860-7.511, respectively) for delayed pneumothorax. The rate of chest tube insertion was significantly (p < 0.001) higher in delayed pneumothorax.

Conclusion: Pneumothorax tends to occur immediately after CTLB in patients with emphysema, lower lobe lesion, and long intrapulmonary biopsy track. Further attention and warnings are needed for those with multiple punctures of small lesions involving upper lobes due to the possibility of delayed development of pneumothorax and higher requirement for chest tube drainage.

Citing Articles

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Weinand J, Du Pisanie L, Ngeve S, Commander C, Yu H PLoS One. 2023; 18(4):e0284145.

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References

Takeshita J, Masago K, Kato R, Hata A, Kaji R, Fujita S . CT-guided fine-needle aspiration and core needle biopsies of pulmonary lesions: a single-center experience with 750 biopsies in Japan. AJR Am J Roentgenol. 2014; 204(1):29-34. DOI: 10.2214/AJR.14.13151. View

Lu C, Hsiao C, Chang Y, Lee J, Shih J, Wu L . Percutaneous computed tomography-guided coaxial core biopsy for small pulmonary lesions with ground-glass attenuation. J Thorac Oncol. 2011; 7(1):143-50. DOI: 10.1097/JTO.0b013e318233d7dd. View

Traill Z, Gleeson F . Delayed pneumothorax after CT-guided percutaneous fine needle aspiration lung biopsy. Thorax. 1997; 52(6):581-2; discussion 575-6. PMC: 1758585. DOI: 10.1136/thx.52.6.581. View

Dennie C, Matzinger F, Marriner J, Maziak D . Transthoracic needle biopsy of the lung: results of early discharge in 506 outpatients. Radiology. 2001; 219(1):247-51. DOI: 10.1148/radiology.219.1.r01ap11247. View

Noh T, Lee C, Kang Y, Kwon S, Yoon H, Kim T . Chest computed tomography (CT) immediately after CT-guided transthoracic needle aspiration biopsy as a predictor of overt pneumothorax. Korean J Intern Med. 2009; 24(4):343-9. PMC: 2784978. DOI: 10.3904/kjim.2009.24.4.343. View

Kim J, Park C, Lee S, Goo J . Rapid needle-out patient-rollover approach after cone beam CT-guided lung biopsy: effect on pneumothorax rate in 1,191 consecutive patients. Eur Radiol. 2015; 25(7):1845-53. DOI: 10.1007/s00330-015-3601-y. View

Romano M, Griffo S, Gentile M, Mainenti P, Tamburrini O, Iaccarino V . CT guided percutaneous fine needle biopsy of small lung lesions in outpatients. Safety and efficacy of the procedure compared to inpatients. Radiol Med. 2004; 108(3):275-82. View

Byrd Jr R, Roy T . Delayed chest radiographs and the diagnosis of pneumothorax following CT-guided fine needle aspiration of pulmonary lesions. Respir Med. 1999; 93(6):379-81. DOI: 10.1053/rmed.1999.0573. View

Mills M, Choi J, El-Haddad G, Sweeney J, Biebel B, Robinson L . Retrospective analysis of technical success rate and procedure-related complications of 867 percutaneous CT-guided needle biopsies of lung lesions. Clin Radiol. 2017; 72(12):1038-1046. DOI: 10.1016/j.crad.2017.07.023. View

10.

Anzidei M, Porfiri A, Andrani F, Di Martino M, Saba L, Catalano C . Imaging-guided chest biopsies: techniques and clinical results. Insights Imaging. 2017; 8(4):419-428. PMC: 5519500. DOI: 10.1007/s13244-017-0561-6. View

11.

MOORE E, Shepard J, McLoud T, Templeton P, Kosiuk J . Positional precautions in needle aspiration lung biopsy. Radiology. 1990; 175(3):733-5. DOI: 10.1148/radiology.175.3.2343123. View

12.

Aberle D, Adams A, Berg C, Black W, Clapp J, Fagerstrom R . Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011; 365(5):395-409. PMC: 4356534. DOI: 10.1056/NEJMoa1102873. View

13.

Huo Y, Chan M, Habib A, Lui I, Ridley L . Pneumothorax rates in CT-Guided lung biopsies: a comprehensive systematic review and meta-analysis of risk factors. Br J Radiol. 2019; 93(1108):20190866. PMC: 7362905. DOI: 10.1259/bjr.20190866. View

14.

Boskovic T, Stanic J, Pena-Karan S, Zarogoulidis P, Drevelegas K, Katsikogiannis N . Pneumothorax after transthoracic needle biopsy of lung lesions under CT guidance. J Thorac Dis. 2014; 6 Suppl 1:S99-S107. PMC: 3966161. DOI: 10.3978/j.issn.2072-1439.2013.12.08. View

15.

Perlmutt L, Braun S, NEWMAN G, Oke E, Dunnick N . Timing of chest film follow-up after transthoracic needle aspiration. AJR Am J Roentgenol. 1986; 146(5):1049-50. DOI: 10.2214/ajr.146.5.1049. View

16.

Elshafee A, Karch A, Ringe K, Shin H, Raatschen H, Soliman N . Complications of CT-guided lung biopsy with a non-coaxial semi-automated 18 gauge biopsy system: Frequency, severity and risk factors. PLoS One. 2019; 14(3):e0213990. PMC: 6422294. DOI: 10.1371/journal.pone.0213990. View

17.

Wu C, Maher M, Shepard J . Complications of CT-guided percutaneous needle biopsy of the chest: prevention and management. AJR Am J Roentgenol. 2011; 196(6):W678-82. DOI: 10.2214/AJR.10.4659. View

18.

Taleb S, Jalaeian H, Frank N, Golzarian J, DSouza D . Is a Routine Chest X-ray Necessary in Every Patient After Percutaneous CT-Guided Lung Biopsy? A Retrospective Review of 278 Cases. Cardiovasc Intervent Radiol. 2017; 40(9):1415-1420. DOI: 10.1007/s00270-017-1632-2. View

19.

Ohno Y, Hatabu H, Takenaka D, Higashino T, Watanabe H, Ohbayashi C . CT-guided transthoracic needle aspiration biopsy of small (< or = 20 mm) solitary pulmonary nodules. AJR Am J Roentgenol. 2003; 180(6):1665-9. DOI: 10.2214/ajr.180.6.1801665. View

20.

Shifren A, Mecham R . The stumbling block in lung repair of emphysema: elastic fiber assembly. Proc Am Thorac Soc. 2006; 3(5):428-33. PMC: 2658707. DOI: 10.1513/pats.200601-009AW. View