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Maxwell AWP, Abtin F, Fintelmann FJ, Baird GL, Suh RD, Sofocleous CT, Solomon SB. Transthoracic Needle Biopsy Is a Safe and Effective Diagnostic Procedure. J Am Coll Radiol 2024; 21:545-546. [PMID: 37302679 DOI: 10.1016/j.jacr.2022.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 11/16/2022] [Indexed: 06/13/2023]
Affiliation(s)
- Aaron W P Maxwell
- Assistant Professor of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Director of Interventional Oncology, Director, Image-Guided Therapies Research Laboratory.
| | - Fereidoun Abtin
- Professor of Radiology, David Geffen School of Medicine at UCLA, Cardiothoracic and Interventional Section, Director of Cardiothoracic Fellowship, Director of Santa Monica Outpatient Practice, Santa Monica, California. https://twitter.com/DoctorDoon
| | - Florian J Fintelmann
- Associate Professor of Radiology, Harvard Medical School, and Officer, Radiology Visiting Research Fellowships, Head, Thoracic Imaging Percutaneous Thermal Ablation, Massachusetts General Hospital, Boston, Massachusetts; Society of Thoracic Radiology, Society of Interventional Oncology, and ACR. https://twitter.com/F_Fintelmann_MD
| | - Grayson L Baird
- Associate Professor of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Senior Research Scientist, Biostatistics, Epidemiology, & Research Design Core, Director, Radiology Human Factors Lab, Providence, Rhode Island
| | - Robert D Suh
- Professor of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, California. https://twitter.com/RSuhmednet.ucla.edu
| | - Constantinos T Sofocleous
- Professor of Radiology, Weill Cornell Medical College, Memorial Sloan Kettering Cancer Center, New York, New York; leadership roles with Society of Interventional Oncology as Board of Directors, Society of Interventional Radiology as Executive Council. https://twitter.com/CostiIsHere
| | - Stephen B Solomon
- Professor of Radiology, Weill Cornell Medical College, Enid A. Haupt Endowed Chair in Clinical Investigation, Chief of Interventional Radiology, Memorial Sloan Kettering Cancer Center, New York, New York. https://twitter.com/solomonsmskcc.org
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Dyas AR, Stuart CM, Fei Y, Cotton JL, Colborn KL, Weyant MJ, Randhawa SK, David EA, Mitchell JD, Scott CD, Meguid RA. The association between patient preoperative disposition and outcomes after diagnostic lung biopsy. J Thorac Dis 2024; 16:1141-1150. [PMID: 38505021 PMCID: PMC10944776 DOI: 10.21037/jtd-23-1724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 12/29/2023] [Indexed: 03/21/2024]
Abstract
Background Surgical diagnostic lung biopsy (DLB) is performed to guide the management of pulmonary disease with unclear etiology. However, the utilization of surgical DLB in critically ill patients remains unclear. The purpose of this study was to determine if patient preoperative disposition impacts complication rates after DLB. Methods This was retrospective cohort study using electronic health record (EHR) data at one academic institution [2013-2021]. Patients who underwent DLB were identified using current procedural terminology (CPT) codes and cohorted based on preoperative disposition. The primary outcome was 30-day mortality; secondary outcomes were overall morbidity, individual complications, and changes to medical therapy. Complication rates were compared using chi-squared tests, Fisher's exact tests, or analysis of variance (ANOVA). Multivariable logistic regression was performed to generate risk-adjusted odds ratios (ORs) for each complication. Results Of 285 patients, 238 (83.5%) presented from home, 26 (9.1%) from inpatient floor units, and 21 (7.4%) from intensive care units (ICUs). Patients requiring ICU had the highest 30-day rates of mortality, overall morbidity, and all individual complications (all P<0.05). After risk adjustment, non-ICU inpatients had higher odds of postoperative ventilator use, prolonged ventilation, and ICU need than outpatients (all P<0.05). Preoperative ICU disposition was associated with increased OR of 30-day mortality [OR, 70.92; 95% confidence interval (CI): 5.55-906.32] and overall morbidity (OR, 7.27; 95% CI: 1.93-27.42) compared to patients with other preoperative dispositions. There were no differences in changes to medical therapy between the cohorts. Conclusions Patients requiring ICU before DLB had significantly higher risk-adjusted rates of mortality and postoperative complications than outpatients and other inpatients. A clear benefit from tissue diagnosis should be defined prior to performing DLB on critically ill patients.
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Affiliation(s)
- Adam R. Dyas
- Department of Surgery, University of Colorado, Aurora, CO, USA
- Surgical Outcomes and Applied Research, University of Colorado, Aurora, CO, USA
| | - Christina M. Stuart
- Department of Surgery, University of Colorado, Aurora, CO, USA
- Surgical Outcomes and Applied Research, University of Colorado, Aurora, CO, USA
| | - Yizhou Fei
- Surgical Outcomes and Applied Research, University of Colorado, Aurora, CO, USA
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado, Aurora, CO, USA
| | - Jake L. Cotton
- Department of Surgery, University of Colorado, Aurora, CO, USA
- Surgical Outcomes and Applied Research, University of Colorado, Aurora, CO, USA
| | - Kathryn L. Colborn
- Surgical Outcomes and Applied Research, University of Colorado, Aurora, CO, USA
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado, Aurora, CO, USA
- Department of Medicine, University of Colorado, Aurora, CO, USA
| | - Michael J. Weyant
- Division of Cardiothoracic Surgery, Inova Health System, Falls Church, VA, USA
| | | | | | | | - Christopher D. Scott
- Division of Cardiothoracic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Robert A. Meguid
- Department of Surgery, University of Colorado, Aurora, CO, USA
- Surgical Outcomes and Applied Research, University of Colorado, Aurora, CO, USA
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado, Aurora, CO, USA
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Impact of Comorbidities on Lung Cancer Screening Evaluation. Clin Lung Cancer 2022; 23:402-409. [PMID: 35641376 PMCID: PMC9814245 DOI: 10.1016/j.cllc.2022.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 03/25/2022] [Accepted: 03/28/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVES We used data from the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial to examine the impact of self-reported chronic obstructive pulmonary disease, coronary artery disease, stroke, and diabetes mellitus on diagnostic complications in lung cancer screening evaluation. METHODS In our analysis, we included individuals from the usual care and intervention (annual chest x-ray) of the lung cancer screening trial with equal or greater than 55 years of age with a 20 pack-year smoking history who had undergone an invasive procedure. We performed multivariate logistic regression analysis to estimate the association of comorbidity on procedure complication. Our primary outcome was the incidence of major or moderate complications. RESULTS Features associated with high-risk complication included older age (OR = 1.03 per year, P = .001), history of coronary artery disease (OR = 1.40, P = .03), history of diabetes mellitus (OR = 0.41, P < .001, current smoking status (OR = 1.46, P ≤ .001), surgical biopsy (OR = 7.39, P < .001), needle biopsy (OR = 1.94, P < .001), and other invasive procedure (OR = 1.58, P < .001). We did not find an associated with complication and history of stroke (OR = 0.84, P = .53) or chronic obstructive pulmonary disease (OR = 1.27, P = .06). CONCLUSION Patient and procedure-level factors may alter the benefits of lung cancer screening. Data concerning individual risk factors and high-risk complications should therefore be incorporated into diagnostic algorithms to optimize clinical benefit and minimize harm. Further study and validation of the risk factors identified herein are warranted.
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Practical consideration for successful sequential tumor biopsies in first-in-human trials. Invest New Drugs 2022; 40:841-849. [PMID: 35404018 PMCID: PMC9288361 DOI: 10.1007/s10637-022-01236-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 03/11/2022] [Indexed: 11/23/2022]
Abstract
In first-in-human (FIH) trials, sequential tumor biopsies, i.e., two consecutive tumor biopsies, the first performed at baseline (pretreatment) and the second during the early treatment period (on-treatment), provide proof of concept in investigational new drugs. We evaluated the success of sequential tumor biopsies in FIH trials, and explored approaches for improved success rates. We retrospectively reviewed the sequential tumor biopsies required in 17 of 52 FIH trials conducted from 2015 to 2020. One hundred and thirty-eight patients were identified. Success of either pretreatment or on-treatment biopsy alone, and of sequential tumor biopsies, was defined as the acquisition of viable tumor cells and as obtaining tumor cells from both biopsy specimens, respectively. The success rates of pretreatment and on-treatment biopsy were 98.6% and 94.2%, respectively, and of sequential tumor biopsies was 70.3%. Adverse events associated with the pretreatment biopsies (33.3% positive; 72.0% negative) and timing of the first imaging assessment (before on-treatment biopsy = 40.0%; after on-treatment biopsy = 82.7%) correlated with successful sequential tumor biopsies. The reasons for unsuccessful sequential tumor biopsies could be categorized into two groups: 1) patient refusal of the on-treatment biopsy (most frequently due to early disease progression); and 2) absence of tumor cells in the pretreatment or on-treatment biopsy specimen. We propose an approach to achieving greater success in sequential tumor biopsies in FIH trials; the first imaging assessment during the study should be scheduled after on-treatment biopsy. (Registration number UMIN000042487, Date of registration November 18, 2020).
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Weinfurtner K, Cho J, Ackerman D, Chen JX, Woodard A, Li W, Ostrowski D, Soulen MC, Dagli M, Shamimi-Noori S, Mondschein J, Sudheendra D, Stavropoulos SW, Reddy S, Redmond J, Khaddash T, Jhala D, Siegelman ES, Furth EE, Hunt SJ, Nadolski GJ, Kaplan DE, Gade TPF. Variability in biopsy quality informs translational research applications in hepatocellular carcinoma. Sci Rep 2021; 11:22763. [PMID: 34815453 PMCID: PMC8611010 DOI: 10.1038/s41598-021-02093-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 10/18/2021] [Indexed: 12/19/2022] Open
Abstract
In the era of precision medicine, biopsies are playing an increasingly central role in cancer research and treatment paradigms; however, patient outcomes and analyses of biopsy quality, as well as impact on downstream clinical and research applications, remain underreported. Herein, we report biopsy safety and quality outcomes for percutaneous core biopsies of hepatocellular carcinoma (HCC) performed as part of a prospective clinical trial. Patients with a clinical diagnosis of HCC were enrolled in a prospective cohort study for the genetic, proteomic, and metabolomic profiling of HCC at two academic medical centers from April 2016 to July 2020. Under image guidance, 18G core biopsies were obtained using coaxial technique at the time of locoregional therapy. The primary outcome was biopsy quality, defined as tumor fraction in the core biopsy. 56 HCC lesions from 50 patients underwent 60 biopsy events with a median of 8 core biopsies per procedure (interquartile range, IQR, 7–10). Malignancy was identified in 45/56 (80.4%, 4 without pathology) biopsy events, including HCC (40/56, 71.4%) and cholangiocarcinoma (CCA) or combined HCC-CCA (5/56, 8.9%). Biopsy quality was highly variable with a median of 40% tumor in each biopsy core (IQR 10–75). Only 43/56 (76.8%) and 23/56 (41.1%) samples met quality thresholds for genomic or metabolomic/proteomic profiling, respectively, requiring expansion of the clinical trial. Overall and major complication rates were 5/60 (8.3%) and 3/60 (5.0%), respectively. Despite uniform biopsy protocol, biopsy quality varied widely with up to 59% of samples to be inadequate for intended purpose. This finding has important consequences for clinical trial design and highlights the need for quality control prior to applications in which the presence of benign cell types may substantially alter findings.
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Affiliation(s)
- Kelley Weinfurtner
- Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, PA, USA.,Penn Image-Guided Interventions Laboratory, University of Pennsylvania, Philadelphia, PA, USA
| | - Joshua Cho
- Penn Image-Guided Interventions Laboratory, University of Pennsylvania, Philadelphia, PA, USA.,Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Daniel Ackerman
- Penn Image-Guided Interventions Laboratory, University of Pennsylvania, Philadelphia, PA, USA.,Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - James X Chen
- Vascular & Interventional Specialists of Charlotte Radiology, Charlotte, NC, USA
| | - Abashai Woodard
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Wuyan Li
- Penn Image-Guided Interventions Laboratory, University of Pennsylvania, Philadelphia, PA, USA.,Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - David Ostrowski
- Penn Image-Guided Interventions Laboratory, University of Pennsylvania, Philadelphia, PA, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael C Soulen
- Division of Interventional Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Mandeep Dagli
- Division of Interventional Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Susan Shamimi-Noori
- Division of Interventional Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Jeffrey Mondschein
- Division of Interventional Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Deepak Sudheendra
- Division of Interventional Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Shilpa Reddy
- Division of Interventional Radiology, University of Pennsylvania, Philadelphia, PA, USA.,Corporal Michael J Cresenz VA Medical Center, Philadelphia, PA, USA
| | - Jonas Redmond
- Division of Interventional Radiology, University of Pennsylvania, Philadelphia, PA, USA.,Corporal Michael J Cresenz VA Medical Center, Philadelphia, PA, USA
| | - Tamim Khaddash
- Division of Interventional Radiology, University of Pennsylvania, Philadelphia, PA, USA.,Corporal Michael J Cresenz VA Medical Center, Philadelphia, PA, USA
| | - Darshana Jhala
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Evan S Siegelman
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Emma E Furth
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Stephen J Hunt
- Penn Image-Guided Interventions Laboratory, University of Pennsylvania, Philadelphia, PA, USA.,Division of Interventional Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Gregory J Nadolski
- Penn Image-Guided Interventions Laboratory, University of Pennsylvania, Philadelphia, PA, USA.,Corporal Michael J Cresenz VA Medical Center, Philadelphia, PA, USA
| | - David E Kaplan
- Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, PA, USA.,Penn Image-Guided Interventions Laboratory, University of Pennsylvania, Philadelphia, PA, USA.,Corporal Michael J Cresenz VA Medical Center, Philadelphia, PA, USA
| | - Terence P F Gade
- Penn Image-Guided Interventions Laboratory, University of Pennsylvania, Philadelphia, PA, USA. .,Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA. .,Division of Interventional Radiology, University of Pennsylvania, Philadelphia, PA, USA. .,Corporal Michael J Cresenz VA Medical Center, Philadelphia, PA, USA. .,Radiology and Cancer Biology, University of Pennsylvania Perelman School of Medicine, 652 BRB II/III, 421 Curie Blvd, Philadelphia, PA, 19104-6160, USA.
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Bi K, Xia DM, Fan L, Ye XF, Zhang Y, Shen MJ, Chen HW, Cong Y, Zhu HM, Tang CH, Yuan J, Wang Y. Development and Prospective Validation of an Ultrasound Prediction Model for the Differential Diagnosis of Benign and Malignant Subpleural Pulmonary Lesions: A Large Ambispective Cohort Study. Front Oncol 2021; 11:656060. [PMID: 34026629 PMCID: PMC8132998 DOI: 10.3389/fonc.2021.656060] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 04/01/2021] [Indexed: 12/24/2022] Open
Abstract
Objective To develop and prospective validate an ultrasound (US) prediction model to differentiate between benign and malignant subpleural pulmonary lesions (SPLs). Methods This study was conducted retrospectively from July 2017 to December 2018 (development cohort [DC], n = 592) and prospectively from January to April 2019 (validation cohort [VC], n = 220). A total of 18 parameters of B-mode US and contrast-enhanced US (CEUS) were acquired. Based on the DC, a model was developed using binary logistic regression. Then its discrimination and calibration were verified internally in the DC and externally in the VC, and its diagnostic performance was compared with those of the existing US diagnostic criteria in the two cohorts. The reference criteria were from the comprehensive diagnosis of clinical-radiological-pathological made by two senior respiratory physicians. Results The model was eventually constructed with 6 parameters: the angle between lesion border and thoracic wall, basic intensity, lung-lesion arrival time difference, ratio of arrival time difference, vascular sign, and non-enhancing region type. In both internal and external validation, the model provided excellent discrimination of benign and malignant SPLs (C-statistic: 0.974 and 0.980 respectively), which is higher than that of “lesion-lung AT difference ≥ 2.5 s” (C-statistic: 0.842 and 0.777 respectively, P <0.001) and “AT ≥ 10 s” (C-statistic: 0.688 and 0.641 respectively, P <0.001) and the calibration curves of the model showed good agreement between actual and predictive malignancy probabilities. As for the diagnosis performance, the sensitivity and specificity of the model [sensitivity: 94.82% (DC) and 92.86% (VC); specificity: 92.42% (DC) and 92.59% (VC)] were higher than those of “lesion-lung AT difference ≥ 2.5 s” [sensitivity: 88.11% (DC) and 80.36% (VC); specificity: 80.30% (DC) and 75.00% (VC)] and “AT ≥ 10 s” [sensitivity: 64.94% (DC) and 61.61% (VC); specificity: 72.73% (DC) and 66.67% (VC)]. Conclusion The prediction model integrating multiple parameters of B-mode US and CEUS can accurately predict the malignancy probability, so as to effectively differentiate between benign and malignant SPLs, and has better diagnostic performance than the existing US diagnostic criteria. Clinical Trial Registration www.chictr.org.cn, identifier ChiCTR1800019828.
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Affiliation(s)
- Ke Bi
- Department of Ultrasound, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.,Department of Pathology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - De-Meng Xia
- Department of Emergency, Changhai Hospital, The Naval Medical University, Shanghai, China.,Department of Orthopaedics, The Naval Hospital of Eastern Theater Command of People's Liberation Army of China (PLA), Zhoushan, China
| | - Lin Fan
- Shanghai Clinic and Research Center of Tuberculosis, Department of Tuberculosis, Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiao-Fei Ye
- Department of Health Statistics, The Naval Medical University, Shanghai, China
| | - Yi Zhang
- Department of Ultrasound, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Meng-Jun Shen
- Department of Ultrasound, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hong-Wei Chen
- Department of Ultrasound, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yang Cong
- Department of Ultrasound, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hui-Ming Zhu
- Department of Ultrasound, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Chun-Hong Tang
- Department of Ultrasound, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jing Yuan
- Department of Ultrasound, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yin Wang
- Department of Ultrasound, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
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A Retrospective Multi-Site Academic Center Analysis of Pneumothorax and Associated Risk Factors after CT-Guided Percutaneous Lung Biopsy. Lung 2021; 199:299-305. [PMID: 33876295 DOI: 10.1007/s00408-021-00445-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 03/25/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To assess the risk factors, incidence and significance of pneumothorax in patients undergoing CT-guided lung biopsy. METHODS Patients who underwent a CT-guided lung biopsy between August 10, 2010 and September 19, 2016 were retrospectively identified. Imaging was assessed for immediate and delayed pneumothorax. Records were reviewed for presence of risk factors and the frequency of complications requiring chest tube placement. 604 patients were identified. Patients who underwent chest wall biopsy (39) or had incomplete data (9) were excluded. RESULTS Of 556 patients (average age 66 years, 50.2% women) 26.3% (146/556) had an immediate pneumothorax and 2.7% (15/556) required chest tube placement. 297/410 patients without pneumothorax had a delayed chest X-ray. Pneumothorax developed in 1% (3/297); one patient required chest tube placement. Pneumothorax risk was associated with smaller lesion sizes (OR 0.998; 95% CI (0.997, 0.999); [p = 0.002]) and longer intrapulmonary needle traversal (OR 1.055; 95% CI (1.033, 1.077); [p < 0.001]). Previous ipsilateral lung surgery (OR 0.12; 95% CI (0.031, 0.468); [p = 0.002]) and longer needle traversal through subcutaneous tissue (OR 0.976; 95% CI (0.96, 0.992); [p = 0.0034]) were protective of pneumothorax. History of lung cancer, biopsy technique, and smoking history were not significantly associated with pneumothorax risk. CONCLUSION Delayed pneumothorax after CT-guided lung biopsy is rare, developing in 1% of our cohort. Pneumothorax is associated with smaller lesion size and longer intrapulmonary needle traversal. Previous ipsilateral lung surgery and longer needle traversal through subcutaneous tissues are protective of pneumothorax. Stratifying patients based on pneumothorax risk may safely obviate standard post-biopsy delayed chest radiographs.
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von Itzstein MS, Gupta A, Kernstine KH, Mara KC, Khanna S, Gerber DE. Increased reporting but decreased mortality associated with adverse events in patients undergoing lung cancer surgery: Competing forces in an era of heightened focus on care quality? PLoS One 2020; 15:e0231258. [PMID: 32271810 PMCID: PMC7145007 DOI: 10.1371/journal.pone.0231258] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 03/19/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Advances in surgical techniques have improved clinical outcomes and decreased complications. At the same time, heightened attention to care quality has resulted in increased identification of hospital-acquired adverse events. We evaluated these divergent effects on the reported safety of lung cancer resection. METHODS AND MATERIALS We analyzed hospital-acquired adverse events in patients undergoing lung cancer resection using the National Hospital Discharge Survey (NHDS) database from 2001-2010. Demographics, diagnoses, and procedures data were abstracted using ICD-9 codes. We used the Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators (PSI) to identify hospital-acquired adverse events. Weighted analyses were performed using t-tests and chi-square. RESULTS A total of 302,444 hospitalizations for lung cancer resection and were included in the analysis. Incidence of PSI increased over time (28% in 2001-2002 vs 34% in 2009-2010; P<0.001). Those with one or more PSI had increased in-hospital mortality (aOR = 11.1; 95% CI, 4.7-26.1; P<0.001) and prolonged hospitalization (12.5 vs 7.8 days; P<0.001). However, among those with PSI, in-hospital mortality decreased over time, from 17% in 2001-2002 to 2% in 2009-2010. CONCLUSIONS In a recent ten-year period, documented rates of adverse events associated with lung cancer resection increased. Despite this increase in safety events, we observed that mortality decreased. Because such metrics may be incorporated into hospital rankings and reimbursement considerations, adverse event coding consistency and content merit further evaluation.
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Affiliation(s)
- Mitchell S. von Itzstein
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, United States of America
| | - Arjun Gupta
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, United States of America
| | - Kemp H. Kernstine
- Department of Cardiothoracic Surgery, UT Southwestern Medical Center, Dallas, TX, United States of America
| | - Kristin C. Mara
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States of America
| | - Sahil Khanna
- Division of Gastroenterology, Mayo Clinic, Rochester, MN, United States of America
| | - David E. Gerber
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, United States of America
- Department of Population & Data Sciences, UT Southwestern Medical Center, Dallas, TX, United States of America
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center Dallas, TX, United States of America
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