Manual Aspiration of a Pneumothorax After CT-guided Lung Biopsy: Outcomes and Risk Factors

Overview

Journal Br J Radiol

Publisher Oxford University Press

Specialty Radiology

Date 2023 Jul 2

PMID 37393532

Authors

Michael Vinchill Chan

Zahra Afraz

Ya Ruth Huo

Sonja Kandel

Patrik Rogalla

Affiliations

Soon will be listed here.

Abstract

Objective: Quantify the outcomes following pneumothorax aspiration and influence upon chest drain insertion.

Methods: This was a retrospective cohort study of patients who underwent aspiration for the treatment of a pneumothorax following a CT percutaneous transthoracic lung biopsy (CT-PTLB) from January 1, 2010 to October 1, 2020 at a tertiary center. Patient, lesion and procedural factors associated with chest drain insertion were assessed with univariate and multivariate analyses.

Results: A total of 102 patients underwent aspiration for a pneumothorax following CT-PTLB. Overall, 81 patients (79.4%) had a successful pneumothorax aspiration and were discharged home on the same day. In 21 patients (20.6%), the pneumothorax continued to increase post-aspiration and required chest drain insertion with hospital admission. Significant risk factors requiring chest drain insertion included upper/middle lobe biopsy location [odds ratio (OR) 6.46; 95% CI 1.77-23.65, = 0.003], supine biopsy position (OR 7.06; 95% CI 2.24-22.21, < 0.001), emphysema (OR 3.13; 95% CI 1.10-8.87, = 0.028), greater needle depth ≥2 cm (OR 4.00; 95% CI 1.44-11.07, = 0.005) and a larger pneumothorax (axial depth ≥3 cm) (OR 16.00; 95% CI 4.76-53.83, < 0.001). On multivariate analysis, larger pneumothorax size and supine position during biopsy remained significant for chest drain insertion. Aspiration of a larger pneumothorax (radial depths ≥3 cm and ≥4 cm) had a 50% rate of success. Aspiration of a smaller pneumothorax (radial depth 2-3 cm and <2 cm) had an 82.6% and 100% rate of success, respectively.

Conclusion: Aspiration of pneumothorax after CT-PTLB can help reduce chest drain insertion in approximately 50% of patients with larger pneumothoraces and even more so with smaller pneumothoraces (>80%).

Advances In Knowledge: Aspiration of pneumothoraces up to 3 cm was often associated with avoiding chest drain insertion and allowing for earlier discharge.

Citing Articles

Lung Cancer and Interstitial Lung Diseases.

Drakopanagiotakis F, Krauss E, Michailidou I, Drosos V, Anevlavis S, Gunther A Cancers (Basel). 2024; 16(16).

PMID: 39199608 PMC: 11352559. DOI: 10.3390/cancers16162837.

References

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

Yamagami T, Terayama K, Yoshimatsu R, Matsumoto T, Miura H, Nishimura T . Role of manual aspiration in treating pneumothorax after computed tomography-guided lung biopsy. Acta Radiol. 2009; 50(10):1126-33. DOI: 10.3109/02841850903232707. View

Manhire A, Charig M, Clelland C, Gleeson F, Miller R, Moss H . Guidelines for radiologically guided lung biopsy. Thorax. 2003; 58(11):920-36. PMC: 1746503. DOI: 10.1136/thorax.58.11.920. View

ONeill A, McCarthy C, Ridge C, Mitchell P, Hanrahan E, Butler M . Rapid needle-out patient-rollover time after percutaneous CT-guided transthoracic biopsy of lung nodules: effect on pneumothorax rate. Radiology. 2011; 262(1):314-9. DOI: 10.1148/radiol.11103506. View

Faruqi S, Gupta D, Aggarwal A, Jindal S . Role of simple needle aspiration in the management of pneumothorax. Indian J Chest Dis Allied Sci. 2004; 46(3):183-90. 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

Yankelevitz D, Davis S, Henschke C . Aspiration of a large pneumothorax resulting from transthoracic needle biopsy. Radiology. 1996; 200(3):695-7. DOI: 10.1148/radiology.200.3.8756917. View

Gupta S, Wallace M, Cardella J, Kundu S, Miller D, Rose S . Quality improvement guidelines for percutaneous needle biopsy. J Vasc Interv Radiol. 2010; 21(7):969-75. DOI: 10.1016/j.jvir.2010.01.011. View

Huo Y, Chan M, Habib A, Lui I, Ridley L . Post-Biopsy Manoeuvres to Reduce Pneumothorax Incidence in CT-Guided Transthoracic Lung Biopsies: A Systematic Review and Meta-analysis. Cardiovasc Intervent Radiol. 2019; 42(8):1062-1072. DOI: 10.1007/s00270-019-02196-8. View

10.

Nour-Eldin N, Alsubhi M, Emam A, Lehnert T, Beeres M, Jacobi V . Pneumothorax Complicating Coaxial and Non-coaxial CT-Guided Lung Biopsy: Comparative Analysis of Determining Risk Factors and Management of Pneumothorax in a Retrospective Review of 650 Patients. Cardiovasc Intervent Radiol. 2015; 39(2):261-70. DOI: 10.1007/s00270-015-1167-3. View

11.

Occhipinti M, Paoletti M, Bartholmai B, Rajagopalan S, Karwoski R, Nardi C . Spirometric assessment of emphysema presence and severity as measured by quantitative CT and CT-based radiomics in COPD. Respir Res. 2019; 20(1):101. PMC: 6533715. DOI: 10.1186/s12931-019-1049-3. View

12.

Veltri A, Bargellini I, Giorgi L, Almeida P, Akhan O . CIRSE Guidelines on Percutaneous Needle Biopsy (PNB). Cardiovasc Intervent Radiol. 2017; 40(10):1501-1513. DOI: 10.1007/s00270-017-1658-5. View

13.

Wagner J, Hinshaw J, Lubner M, Robbins J, Kim D, Pickhardt P . CT-guided lung biopsies: pleural blood patching reduces the rate of chest tube placement for postbiopsy pneumothorax. AJR Am J Roentgenol. 2011; 197(4):783-8. DOI: 10.2214/AJR.10.6324. View