1
|
Leonhardi J, Dahms U, Schnarkowski B, Struck MF, Höhn AK, Krämer S, Ebel S, Prasse G, Frille A, Denecke T, Meyer HJ. Impact of radiomics features, pulmonary emphysema score and muscle mass on the rate of pneumothorax and chest tube insertion in CT-guided lung biopsies. Respir Res 2024; 25:320. [PMID: 39174980 PMCID: PMC11340115 DOI: 10.1186/s12931-024-02936-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 08/01/2024] [Indexed: 08/24/2024] Open
Abstract
Iatrogenic pneumothorax is a relevant complication of computed tomography (CT)-guided percutaneous lung biopsy. The aim of the present study was to analyze the prognostic significance of texture analysis, emphysema score and muscle mass derived from CT-imaging to predict postinterventional pneumothorax after CT-guided lung biopsy. Consecutive patients undergoing CT-guided percutaneous lung biopsy between 2012 and 2021 were analyzed. Multivariate logistic regression analysis included clinical risk factors and CT-imaging features to detect associations with pneumothorax development. Overall, 479 patients (178 females, mean age 65 ± 11.7 years) underwent CT-guided percutaneous lung biopsy of which 180 patients (37.5%) developed pneumothorax including 55 patients (11.5%) requiring chest tube placement. Risk factors associated with pneumothorax were chronic-obstructive pulmonary disease (COPD) (p = 0.03), age (p = 0.02), total lung capacity (p < 0.01) and residual volume (p = 0.01) as well as interventional parameters needle length inside the lung (p < 0.001), target lesion attached to pleura (p = 0.04), and intervention duration (p < 0.001). The combined model demonstrated a prediction accuracy of the occurrence of pneumothorax with an AUC of 0.78 [95%CI: 0.70-0.86] with a resulting sensitivity 0.80 and a specificity of 0.66. In conclusion, radiomics features of the target lesion and the lung lobe CT-emphysema score are predictive for the occurrence of pneumothorax and need for chest insertion after CT-guided lung biopsy.
Collapse
Affiliation(s)
- Jakob Leonhardi
- Department of Diagnostic and Interventional Radiology, University of Leipzig, 49341/9717400, Leipzig, Germany
| | - Ulrike Dahms
- Department of Diagnostic and Interventional Radiology, University of Leipzig, 49341/9717400, Leipzig, Germany
| | - Benedikt Schnarkowski
- Department of Diagnostic and Interventional Radiology, University of Leipzig, 49341/9717400, Leipzig, Germany
| | - Manuel Florian Struck
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig, Leipzig, Germany
| | - Anne-Kathrin Höhn
- Department of Pathology, University Hospital Leipzig, University of Leipzig, Leipzig, Germany
| | - Sebastian Krämer
- Department of Thoracic Surgery, University Hospital Leipzig, University of Leipzig, Leipzig, Germany
| | - Sebastian Ebel
- Department of Diagnostic and Interventional Radiology, University of Leipzig, 49341/9717400, Leipzig, Germany
| | - Gordian Prasse
- Department of Diagnostic and Interventional Radiology, University of Leipzig, 49341/9717400, Leipzig, Germany
| | - Armin Frille
- Department of Respiratory Medicine, University Hospital Leipzig, University of Leipzig, Leipzig, Germany
| | - Timm Denecke
- Department of Diagnostic and Interventional Radiology, University of Leipzig, 49341/9717400, Leipzig, Germany
| | - Hans-Jonas Meyer
- Department of Diagnostic and Interventional Radiology, University of Leipzig, 49341/9717400, Leipzig, Germany.
| |
Collapse
|
2
|
Lamfichekh Y, Lafay V, Hamam J, Guillien A, Puyraveau M, Behr J, Manzoni P, Calame P, Dalphin JC, Eberst G, Grillet F, Westeel V. Score to Predict the Occurrence of Pneumothorax After Computed Tomography-guided Percutaneous Transthoracic Lung Biopsy. J Thorac Imaging 2023; 38:315-324. [PMID: 37603106 DOI: 10.1097/rti.0000000000000729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
PURPOSE The main objective of this study was to identify risk factors for post-percutaneous transthoracic lung biopsy (PTLB) pneumothorax and to establish and validate a predictive score for pneumothorax occurrence to identify patients eligible for outpatient care. MATERIAL AND METHODS Patients who underwent PTLB between November 1, 2012 and March 1, 2017 were retrospectively evaluated for clinical and radiologic factors potentially related to pneumothorax occurrence. Multivariate logistic regression was used to identify risk factors, and the model coefficient for each factor was used to compute a score. Then, a validation cohort was prospectively evaluated from March 2018 to October 2019. RESULTS Among the 498 eligible patients in the study cohort, pneumothorax occurred in 124 patients (24.9%) and required drainage in 34 patients (6.8%). Pneumothorax risk factors were chronic obstructive pulmonary disease (OR 95% CI 2.28[1.18-4.43]), several passages through the pleura (OR 95% CI 7.71[1.95-30.48]), an anterior biopsy approach (OR 95% CI 6.36 3.82-10.58]), skin-to-pleura distance ≤30 mm (OR 95% CI 2.25[1.09-6.65]), and aerial effusion >10 mm (OR 95% CI 9.27 [5.16-16.65]). Among the 236 patients in the prospective validation cohort, pneumothorax occurred in 18% and 8% were drained. A negative score (<73 points) predicted a probability of pneumothorax occurrence of 7.4% and late evacuation of 2.5% (OR 95% CI respectively 0.18[0.08-0.39] and 0.15[0.04-0.55]) and suggested a reduced length of hospital stay (P=0.009). CONCLUSION This predictive score for pneumothorax secondary to PTLB has high prognostic performance and accuracy to direct patients toward outpatient management. CLINICAL TRIALS NCT03488043.
Collapse
Affiliation(s)
| | - Valentin Lafay
- Department of Chest Disease, University Hospital of Besançon, Besançon
| | - Joffrey Hamam
- Department of Intensive Care Medicine, Hospital of Libourne, Libourne
| | - Alicia Guillien
- Team of Environmental Epidemiology applied to Reproduction and Respiratory Health, IAB, Grenoble Alpes University, Inserm, CNRS, Grenoble
| | | | | | | | | | | | - Guillaume Eberst
- Department of Chest Disease, University Hospital of Besançon, Besançon
- Methodology and Quality of Life in Oncology Unit, University Hospital, Besançon
- UMR: 1098, University of Franche-Comté, Besançon
| | - Franck Grillet
- Department of Radiology
- Department of Radiology, Centre Léon Berard, Lyon, France
| | - Virginie Westeel
- Department of Chest Disease, University Hospital of Besançon, Besançon
- Methodology and Quality of Life in Oncology Unit, University Hospital, Besançon
- UMR: 1098, University of Franche-Comté, Besançon
| |
Collapse
|
3
|
Shera FA, Shera TA, Shah OA, Robbani I, Choh NA, Shaheen F, Gojawari TA. Pneumothorax after CT-Guided Lung Biopsy: What Next? Indian J Radiol Imaging 2023. [DOI: 10.1055/s-0043-1764293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Abstract
Abstract
Background Pneumothorax is the most common complication of computed tomography (CT)-guided lung biopsy. The asymptomatic rate ranges from 17.5 to 72%. The symptomatic rate requiring chest tube insertion is 6 to 18%.
Aims This article studies the role of management of postbiopsy pneumothoraces by needle aspiration and pigtail catheter insertion.
Methods This was a prospective observational study conducted over 2 years. Postbiopsy and prior to withdrawing the coaxial cannula a CT data set was obtained to detect and quantify pneumothoraces as mild, moderate, and severe. In all asymptomatic cases of mild pneumothorax simple observation was done. In all asymptomatic cases of moderate pneumothorax, immediate needle aspiration was performed. In all symptomatic cases, cases with severe pneumothorax, and cases with progressively enlarging pneumothorax small caliber 6 to 8F pigtail catheters were inserted.
Results Ninety-one cases had mild pneumothorax, 42 had moderate pneumothorax, and 18 had severe pneumothorax. In the 91 patients of mild pneumothorax only 1 (1%) patient showed increase in size of pneumothorax on follow-up requiring catheter insertion. In the 42 cases of moderate pneumothorax, which were managed by simple aspiration of pneumothorax, 4 (9.5%) cases showed increase in size of pneumothorax on follow-up. A total 23 cases required pigtail catheter insertion in our study. These constituted 15.2% of pneumothorax cases. The mean duration of catheterization in our study was 3.74 ± 1.09 days.
Conclusion Majority of pneumothoraces are benign and do not require any intervention, just observation. Manual aspiration is an effective way of treating moderate pneumothoraces with success rate of 90%, thereby reducing the number of cases requiring catheter insertion; however, close observation is required as few cases may progress to severe pneumothorax and require pigtail insertion. Only a small percentage of biopsy cases (6.4%) require catheter insertion which is a safe and effective treatment.
Collapse
Affiliation(s)
- Faiz Altaf Shera
- Department of Radiodiagnosis and Imaging, Sher-i-Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, India
| | - Tahleel Altaf Shera
- Department of Radiodiagnosis and Imaging, Sher-i-Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, India
| | - Omair Ashraf Shah
- Department of Radiodiagnosis and Imaging, Sher-i-Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, India
| | - Irfan Robbani
- Department of Radiodiagnosis and Imaging, Sher-i-Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, India
| | - Naseer Ahmad Choh
- Department of Radiodiagnosis and Imaging, Sher-i-Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, India
| | - Feroze Shaheen
- Department of Radiodiagnosis and Imaging, Sher-i-Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, India
| | - Tariq Ahmad Gojawari
- Department of Radiodiagnosis and Imaging, Sher-i-Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, India
| |
Collapse
|
4
|
Safe Zone to Avoid Pneumothorax in a CT-Guided Lung Biopsy. J Clin Med 2023; 12:jcm12030749. [PMID: 36769398 PMCID: PMC9918264 DOI: 10.3390/jcm12030749] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/15/2023] [Accepted: 01/16/2023] [Indexed: 01/20/2023] Open
Abstract
Pneumothorax is one of the most frequent complications of computed tomography (CT)-guided lung biopsies. We aim to identify the safe zone of the needle-pleura angle during a CT-guided lung biopsy. Fifty-two patients underwent CT-guided lung biopsies between January 2020 and September 2022 (27 males, 25 females, median age 70 years). Right and left needle angles were measured and correlated to the incidence of pneumothorax. The minimum delta (δmin) was calculated as the absolute value of the difference between a 90° angle and the right and left angles. t-test p-values for δmin were conducted. We recorded 29 patients with pneumothorax, including intraprocedural and transient, postprocedural with minimal symptoms, or postprocedural requiring a chest tube insertion. Thirty-two patients had a δmin ≥ 10°, while 20 had a δmin < 10°. Of the patients with a δmin < 10°, 30% experienced pneumothorax compared to 71.8% in patients with δmin ≥ 10° (p = 0.0023). The study results show that as the needle's angle deviates from the perpendicular, with an absolute value of more than 10°, the likelihood of pneumothorax increases significantly. A needle-pleura angle between 80° and 100° gives the operator a safe zone to reduce the risk of pneumothorax.
Collapse
|
5
|
Ultrasound-guided percutaneous biopsy of peripheral pulmonary lesions with 16-G core needles: study of factors that influence sample adequacy and safety. Clin Radiol 2023; 78:24-32. [PMID: 36116968 DOI: 10.1016/j.crad.2022.08.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 08/04/2022] [Accepted: 08/13/2022] [Indexed: 01/07/2023]
Abstract
AIM To explore the factors that influence sample adequacy and safety of ultrasound (US)-guided biopsy for peripheral pulmonary lesions (PPLs) with 16-G needles. MATERIALS AND METHODS A total of 263 patients (150 men, 113 women; mean age, 60.7 ± 13 years) who received US-guided biopsy for PPLs with 16-G needles from July 2017 to March 2021 were included. Variables including patient demographics, lesion location, lesion size, proportion of lesion necrosis, presence of emphysema, presence of bullae around lesion, patient position, and number of needle passes were recorded. Univariate analysis and multivariable logistic regression analysis were performed to explore the factors that influence sample adequacy and safety. RESULTS Biopsy specimens were adequate for diagnosis in 242/263 (92%) cases. Multivariable logistic regression analysis revealed lesion size was significantly associated with sample adequacy (p=0.005, odds ratio [OR] = 1.039). The incidence of overall complication rate was 10.6% (28/263), including pneumothorax and haemorrhage, which occurred in 2.7% (7/263) and 9.9% (26/263) of patients, respectively. Patient position (lateral versus supine) was associated with overall complication rates (p=0.029, OR=3.407) and haemorrhage (p=0.013, OR=4.870). The presence of bullae around the lesion (p=0.026, OR=73.128) was an independent factor associated with pneumothorax. CONCLUSION US-guided percutaneous biopsy for PPLs with 16-G needles is effective and safe. Sample adequacy is significantly affected by lesion size. Patient lateral position is a risk factor for overall complication and haemorrhage. The presence of bullae around the lesion is a predictor of pneumothorax.
Collapse
|
6
|
Zhang S, Guo F, Wang H, Chen M, Huang G, Zhu Y, Zheng W, Zheng B, Chen C. Comparative analysis of electromagnetic navigation bronchoscopy versus computed tomography-guided lung puncture for the sampling of indeterminate pulmonary nodules in the middle of an anatomic lung segment: A cohort study. Thorac Cancer 2022; 14:149-155. [PMID: 36464771 PMCID: PMC9834696 DOI: 10.1111/1759-7714.14726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/25/2022] [Accepted: 10/27/2022] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND To compare the diagnostic positive rate and complication rate between the electromagnetic navigation bronchoscopy (ENB) technique and computed tomography (CT)-guided lung puncture for the biopsy of lung nodules located in the middle of an anatomic lung segment. METHODS Electronic medical records of 114 patients who underwent lung nodule biopsy between June 2021 and June 2022 were retrospectively evaluated. In all patients, the nodules were located in the middle third lung segment. To compare the diagnostic positive and complication rates between the two biopsy modalities performed in this lung region, clinical data, complication rates, nodule pathology, and imaging results were reviewed based on nodule characteristics retrieved from the electronic medical records. RESULTS Ninety-three patients underwent CT-guided lung puncture, while the remaining 21 patients underwent the ENB technique. No significant difference was observed in the diagnostic positive rate between the two groups (73.6 and 76.1%, respectively). In the CT-guided lung puncture group, pneumothorax incidence, tube placement, postoperative hemorrhage, and symptomatic hemorrhage rates were 16.1, 6.5, 6.5, and 1.1%, respectively. In contrast, no complications occurred in the ENB group. CONCLUSIONS The ENB technique is a safe and effective method for performing biopsies of pulmonary nodules with a diagnostic positive rate comparable to that of CT-guided lung puncture and with a lower postoperative complication rate.
Collapse
Affiliation(s)
- Shuliang Zhang
- Fujian Key Laboratory of Cardiothoracic Surgery (Fujian Medical University), Fujian Province UniversityFuzhouChina,Department of Thoracic SurgeryFujian Medical University Union HospitalFuzhouChina
| | - Feilong Guo
- Fujian Key Laboratory of Cardiothoracic Surgery (Fujian Medical University), Fujian Province UniversityFuzhouChina,Department of Thoracic SurgeryFujian Medical University Union HospitalFuzhouChina
| | - Hongjin Wang
- Fujian Key Laboratory of Cardiothoracic Surgery (Fujian Medical University), Fujian Province UniversityFuzhouChina,Department of Thoracic SurgeryFujian Medical University Union HospitalFuzhouChina
| | - Maohui Chen
- Fujian Key Laboratory of Cardiothoracic Surgery (Fujian Medical University), Fujian Province UniversityFuzhouChina,Department of Thoracic SurgeryFujian Medical University Union HospitalFuzhouChina
| | - Guanglei Huang
- Fujian Key Laboratory of Cardiothoracic Surgery (Fujian Medical University), Fujian Province UniversityFuzhouChina,Department of Thoracic SurgeryFujian Medical University Union HospitalFuzhouChina
| | - Yong Zhu
- Fujian Key Laboratory of Cardiothoracic Surgery (Fujian Medical University), Fujian Province UniversityFuzhouChina,Department of Thoracic SurgeryFujian Medical University Union HospitalFuzhouChina
| | - Wei Zheng
- Fujian Key Laboratory of Cardiothoracic Surgery (Fujian Medical University), Fujian Province UniversityFuzhouChina,Department of Thoracic SurgeryFujian Medical University Union HospitalFuzhouChina
| | - Bin Zheng
- Fujian Key Laboratory of Cardiothoracic Surgery (Fujian Medical University), Fujian Province UniversityFuzhouChina,Department of Thoracic SurgeryFujian Medical University Union HospitalFuzhouChina
| | - Chun Chen
- Fujian Key Laboratory of Cardiothoracic Surgery (Fujian Medical University), Fujian Province UniversityFuzhouChina,Department of Thoracic SurgeryFujian Medical University Union HospitalFuzhouChina
| |
Collapse
|
7
|
Zhao Y, Bao D, Wu W, Tang W, Xing G, Zhao X. Development and validation of a prediction model of pneumothorax after CT-guided coaxial core needle lung biopsy. Quant Imaging Med Surg 2022; 12:5404-5419. [PMID: 36465829 PMCID: PMC9703113 DOI: 10.21037/qims-22-176] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 09/08/2022] [Indexed: 08/22/2023]
Abstract
BACKGROUND Pneumothorax is the most common complication of computed tomography-guided coaxial core needle biopsy (CCNB) and may be life-threatening. We aimed to evaluate the risk factors and develop a model for predicting pneumothorax in patients undergoing computed tomography-guided CCNB, and to further determine its clinical utility. METHODS Univariate and multivariate logistic regression analyses were conducted to identify independent risk factors for pneumothorax from 18 variables. A predictive model was established using multivariable logistic regression and presented as a nomogram based on a training cohort of 690 patients who underwent computed tomography-guided CCNB. The model was validated in 253 consecutive patients in the validation cohort and 250 patients in the test cohort. The area under the curve was used to determine the predictive accuracy of the proposed model. RESULTS The risk factors associated with pneumothorax after computed tomography-guided CCNB were sex, patient position, lung field, lesion contact with the pleura, lesion size, distance from the pleura to the lesion, presence of emphysema adjacent to the biopsy tract, and crossing fissures. The predictive model that incorporated these predictors showed good predictive performance in the training cohort [area under the curve, 0.71 (95% confidence interval: 0.67-0.75)], validation cohort [0.71 (0.64-0.78)], and internal test cohort [0.68 (0.60-0.75)]. The nomogram also provided excellent calibration and discrimination, and decision curve analysis (DCA) demonstrated its clinical utility. CONCLUSIONS The predictive model showed good performance for pneumothorax after computed tomography-guided CCNB and may help improve individualized preoperative prediction.
Collapse
Affiliation(s)
- Yanfeng Zhao
- Departments of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dan Bao
- Departments of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenli Wu
- Medical Imaging Center, Liaocheng Tumor Hospital, Liaocheng, China
| | - Wei Tang
- Departments of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Gusheng Xing
- Departments of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xinming Zhao
- Departments of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| |
Collapse
|
8
|
Kim DY, Sun JS, Kim EY, Park KJ, You S. Diagnostic accuracy and safety of CT-guided percutaneous lung biopsy with a coaxial cutting needle for the diagnosis of lung cancer in patients with UIP pattern. Sci Rep 2022; 12:15682. [PMID: 36127437 PMCID: PMC9489867 DOI: 10.1038/s41598-022-20030-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 09/07/2022] [Indexed: 11/11/2022] Open
Abstract
This study aimed to assess the diagnostic accuracy and safety of CT-guided percutaneous core needle biopsy (PCNB) with a coaxial needle for the diagnosis of lung cancer in patients with an usual interstitial pneumonia (UIP) pattern of interstitial lung disease. This study included 70 patients with UIP and suspected to have lung cancer. CT-guided PCNB was performed using a 20-gauge coaxial cutting needle. The diagnostic accuracy, sensitivity, specificity, and percentage of nondiagnostic results for PCNB were determined in comparison with the final diagnosis. PCNB-related complications were evaluated. Additionally, the risk factors for nondiagnostic results and pneumothorax were analyzed. The overall diagnostic accuracy, sensitivity, and specificity were 85.7%, 85.5%, and 87.5%, respectively. The percentage of nondiagnostic results was 18.6% (13/70). Two or less biopsy sampling was a risk factor for nondiagnostic results (p = 0.003). The overall complication rate was 35.7% (25/70), and pneumothorax developed in 22 patients (31.4%). A long transpulmonary needle path was a risk factor for the development of pneumothorax (p = 0.007). CT-guided PCNB using a coaxial needle is an effective method with reasonable accuracy and an acceptable complication rate for the diagnosis of lung cancer, even in patients with UIP.
Collapse
Affiliation(s)
- Da Young Kim
- Department of Radiology, Ajou University School of Medicine, 164 Worldcup Road, Yeongtong-gu, Suwon, 16499, Republic of Korea
| | - Joo Sung Sun
- Department of Radiology, Ajou University School of Medicine, 164 Worldcup Road, Yeongtong-gu, Suwon, 16499, Republic of Korea
| | - Eun Young Kim
- Department of Radiology, Hankook Hospital, Cheongju, Republic of Korea
| | - Kyung Joo Park
- Department of Radiology, Ajou University School of Medicine, 164 Worldcup Road, Yeongtong-gu, Suwon, 16499, Republic of Korea
| | - Seulgi You
- Department of Radiology, Ajou University School of Medicine, 164 Worldcup Road, Yeongtong-gu, Suwon, 16499, Republic of Korea.
| |
Collapse
|
9
|
CT-guided lung biopsy: diagnostic accuracy and complication rates of biopsy techniques. MARMARA MEDICAL JOURNAL 2022. [DOI: 10.5472/marumj.1120552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
10
|
Zeng L, Liao H, Ren F, Zhang Y, Wang Q, Xie M. Pneumothorax Induced by Computed Tomography Guided Transthoracic Needle Biopsy: A Review for the Clinician. Int J Gen Med 2021; 14:1013-1022. [PMID: 33790630 PMCID: PMC8001193 DOI: 10.2147/ijgm.s302434] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 03/10/2021] [Indexed: 01/15/2023] Open
Abstract
Percutaneous computed tomography (CT)-guided transthoracic needle biopsy (TTNB) is a valuable procedure for obtaining tissue or cells for diagnosis, which is especially indispensable in thoracic oncology. Pneumothorax and hemoptysis are the most common complications of percutaneous needle biopsy of the lung. According to reports published over the past decades, pneumothorax incidence in patients who underwent TTNB greatly varies. The morbidity of pneumothorax after CT-guided TTNB depends on several factors, including size and depth of lesions, emphysema, the number of pleural surfaces and fissure crossed, etc. Attention to biopsy planning and technique and post-biopsy precautions help to prevent or minimize potential complications. Many measures can be taken to help prevent the progression of a pneumothorax, which in turn might reduce the number of pneumothoraces requiring chest tube placement. A multitude of therapeutic options is available for the treatment of pneumothorax, varying from observation and oxygen treatment, simple manual aspiration, to chest tube placement. When a pneumothorax develops during the biopsy procedure, it can be manually aspirated after the needle is retracted back into the pleural space or by inserting a separate needle into the pleural space. Biopsy side down positioning of the patient after biopsy significantly reduces the incidence of pneumothorax and the requirement of chest tube placement. Aspiration in biopsy side down position is also recommended for treating pneumothorax when simple manual aspiration is unsuccessful or delayed pneumothorax occurred. Chest tube placement is an important treatment strategy for patients with a large or symptomatic pneumothorax. Clinicians are encouraged to understand the development, prevention, and treatment of pneumothorax. Efforts should be made to reduce the incidence of pneumothorax in biopsy planning and post-biopsy precautions. When pneumothorax occurs, appropriate treatment should be adopted to reduce the risk of worsening pneumothorax.
Collapse
Affiliation(s)
- Lichuan Zeng
- Department of Radiology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, People's Republic of China
| | - Huaqiang Liao
- Department of Radiology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, People's Republic of China
| | - Fengchun Ren
- Department of Radiology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, People's Republic of China
| | - Yudong Zhang
- Department of Radiology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, People's Republic of China
| | - Qu Wang
- Department of Ultrasound, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, People's Republic of China
| | - Mingguo Xie
- Department of Radiology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, People's Republic of China
| |
Collapse
|
11
|
Chung C, Kim Y, Park D. Transthoracic Needle Biopsy: How to Maximize Diagnostic Accuracy and Minimize Complications. Tuberc Respir Dis (Seoul) 2020; 83:S17-S24. [PMID: 33272004 PMCID: PMC7837377 DOI: 10.4046/trd.2020.0156] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 12/04/2020] [Indexed: 12/13/2022] Open
Abstract
Although transthoracic needle biopsy (TTNB) was introduced for lung biopsy about 40 years ago, it is still mainstay of pathologic diagnosis in lung cancer, because it is relatively inexpensive and can obtain tissue regardless of the tumor-bronchus relationship. With several technological advances, proceduralists can perform TTNB more safely and accurately. Utilizing ultrasound-guided biopsy for peripheral lesions in contact with the pleura and rapid on-site evaluation during the procedure are expected to make up the weakness of TTNB. However, due to the inherent limitations of the percutaneous approach, the incidence of complications such as pneumothorax or bleeding is inevitably higher than that of other lung biopsy techniques. Thorough understating of each biopsy modality and additional technique are fundamental for maximizing diagnostic accuracy and minimizing the complications.
Collapse
Affiliation(s)
- Chaeuk Chung
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Yoonjoo Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Dongil Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| |
Collapse
|
12
|
Bae K, Ha JY, Jeon KN. Pneumothorax after CT-guided transthoracic lung biopsy: A comparison between immediate and delayed occurrence. PLoS One 2020; 15:e0238107. [PMID: 32834016 PMCID: PMC7446785 DOI: 10.1371/journal.pone.0238107] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 08/10/2020] [Indexed: 12/17/2022] Open
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.
Collapse
Affiliation(s)
- Kyungsoo Bae
- Department of Radiology, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea
- Department of Radiology, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Ji Young Ha
- Department of Radiology, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea
- Department of Radiology, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Kyung Nyeo Jeon
- Department of Radiology, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea
- Department of Radiology, Gyeongsang National University Changwon Hospital, Changwon, Korea
- * E-mail:
| |
Collapse
|
13
|
Impact of quantitative pulmonary emphysema score on the rate of pneumothorax and chest tube insertion in CT-guided lung biopsies. Sci Rep 2020; 10:10978. [PMID: 32620852 PMCID: PMC7335035 DOI: 10.1038/s41598-020-67348-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 05/28/2020] [Indexed: 11/08/2022] Open
Abstract
The aim of this study was to evaluate the risk of pneumothorax and need for chest tube insertion in CT-guided lung biopsies and identify predictors focusing on pulmonary emphysema determined with quantitative computed tomography. To that end, we retrospectively analysed the incidence of pneumothorax and chest tube insertion in 371 CT-guided lung biopsies with respect to the quantitative emphysema score determined with the density mask technique. Other possible impact factors considered were lesion diameter, length of biopsy pathway within the lung parenchyma, lung lobe, needle size, puncture technique, patient positioning and interventionalist's level of experience. Quantitative emphysema scores of the lung were significantly higher in patients who developed instant pneumothorax (27%, p < 0.0001), overall pneumothorax (38%, p = 0.001) and had chest tube insertion (9%, p = 0.006) compared to those who did not when analysed with the Mann-Whitney U-test. In logistic regression analysis with inclusion of the other possible impact factors, the quantitative emphysema score remained a statistically significant predictor for all three output parameters. This was confirmed with least absolute shrinkage and selection operator (Lasso) regression analysis. In conclusion, quantitatively determined pulmonary emphysema is a positive predictor of the pneumothorax rate in CT-guided lung biopsy and likelihood of chest tube insertion.
Collapse
|
14
|
Perilesional emphysema as a predictor of risk of complications from computed tomography-guided transthoracic lung biopsy. Jpn J Radiol 2019; 37:808-816. [PMID: 31541398 DOI: 10.1007/s11604-019-00880-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 09/10/2019] [Indexed: 12/25/2022]
Abstract
PURPOSE This study evaluated whether or not patterns of emphysema and their qualitative and quantitative severity can predict the risk of complications with post-computed tomography (CT)-guided transthoracic lung biopsy (TTLB). MATERIALS AND METHODS Three hundred and ninety-seven patients who underwent CT-guided TTLB in 2010-2018 were retrospectively reviewed. The severity of emphysema and presence of perilesional emphysema were assessed visually using the Fleischner Society classification. Ninety seven of the 397 patients underwent quantitative analysis of emphysema. Complications, including pneumothorax, chest tube insertion, and hemorrhage, were assessed by post-TTLB CT and radiographic imaging. The grade of hemorrhage was categorized into three groups. Independent risk factors for pneumothorax and hemorrhage were assessed by univariate and multivariate logistic regression analyses. RESULTS Pneumothorax occurred in 48.6% of cases and hemorrhage in 70.5%. Perilesional emphysema was significantly associated with pneumothorax (odds ratio 6.720; 95% confidence interval 3.265-13.831, p < 0.001) and hemorrhage (odds ratio 3.877; 95% confidence interval 1.796-8.367; p = 0.001). The severity of visual and quantitative emphysema was not a significant risk factor for pneumothorax or hemorrhage (p > 0.05). Perilesional emphysema was significantly associated with the grade of hemorrhage (p < 0.001). CONCLUSION Perilesional emphysema can estimate the risk of iatrogenic complications from CT-guided TTLB.
Collapse
|
15
|
Does Ipsilateral-Dependent Positioning During Percutaneous Lung Biopsy Decrease the Risk of Pneumothorax? AJR Am J Roentgenol 2018; 212:461-466. [PMID: 30540211 DOI: 10.2214/ajr.18.19871] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The purpose of this study is to determine whether placing patients in an ipsilateral-dependent position during percutaneous CT-guided transthoracic biopsy reduces the pneumothorax rate. MATERIALS AND METHODS Between July 2013 and August 2017, a total of 516 patients (317 men and 199 women; mean age, 66.4 years) underwent core needle biopsies performed using 17- and 18-gauge needles. The overall pneumothorax rate and the rate of pneumothorax requiring drainage catheter insertion were compared between group A (patients placed in an ipsilateral-dependent position) and group B (patients placed in a position other than the ipsilateral-dependent position), with use of a chi-square test or Fisher exact test, as appropriate. Linear regression analysis and multiple regression analysis were performed for risk factors of pneumothorax, including patient characteristics (e.g., emphysema along the needle track), lesion characteristics (e.g., size and position), and biopsy technique characteristics (e.g., needle path length, needle-pleura angle, and fissure crossing). RESULTS For patients in group A and group B, the overall pneumothorax rate (21/94 [22.3%] and 95/422 [22.5%], respectively; p = 0.97) and the rate of pneumothorax requiring drainage catheter insertion (6/94 [6.4%] and 28/422 [6.6%], respectively; p = 0.90) were not statistically different. After multiple regression analysis, the only independent risk factors for pneumothorax and insertion of a drainage catheter were needle path length (p < 0.001 and p = 0.02, respectively), emphysema along the needle track (p = 0.01 and p < 0.001, respectively), and fissure crossing (p = 0.04 and p < 0.001, respectively). CONCLUSION Even though the pneumothorax rate does not appear to be reduced, with the limits of a retrospective evaluation considered, other advantages of the ipsilateral decubitus position exist, including protection of the contralateral lung in patients with severe hemoptysis.
Collapse
|
16
|
CT-guided Transthoracic Core-Needle Biopsies of Mediastinal and Lung Lesions in 235 Consecutive Patients: Factors Affecting the Risks of Complications and Occurrence of a Final Diagnosis of Malignancy. Arch Bronconeumol 2018; 55:297-305. [PMID: 30527558 DOI: 10.1016/j.arbres.2018.09.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 08/29/2018] [Accepted: 09/20/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To assess the impact of patient-, lesion- and procedure-related factors on the risks of complications and final diagnosis of malignancy in PCNB of mediastinal and lung lesions. MATERIAL AND METHODS We studied a large single-center cohort of 235 consecutive patients (66.8% men; 58.5±18.0 years) with a range of thoracic benign and malignant lesions, who underwent PCNB performed along 24 months by a single experienced radiologist. Diagnostic accuracy analyses of PCNB for malignancy were performed, as well as estimations of relative risk and logistic regression models in order to assess possible associations between such factors and malignancy/complications. RESULTS 155 lesions (65.9%) were diagnosed as malignant. Overall accuracy was 91.1%, with sensitivity of 87.1%, specificity of 98.8%, positive predictive value of 99.3%, and negative predictive value of 79.8%. Pneumothorax (49/235; 20.8%) and hemorrhage (37/235; 15.7%) were the most common complications. Emphysema, smoking, older age, intrapulmonary location, deeper location, smaller size, presence of cavitations and irregular contours of the lesions, and smaller needle-pleural angles were the most consistent factors related to the occurrence of complications. Emphysema, older age, smoking, solid and deeper lesions were also significantly associated with a final diagnosis of malignancy after PCNB. CONCLUSION CT-guided PCNB of mediastinal and lung lesions is a safe procedure with high diagnostic accuracy for malignancy.
Collapse
|
17
|
Jeon MC, Kim JO, Jung SS, Park HS, Lee JE, Moon JY, Chung CU, Kang DH, Park DI. CT-Guided Percutaneous Transthoracic Needle Biopsy Using the Additional Laser Guidance System by a Pulmonologist with 2 Years of Experience in CT-Guided Percutaneous Transthoracic Needle Biopsy. Tuberc Respir Dis (Seoul) 2018; 81:330-338. [PMID: 29926547 PMCID: PMC6148095 DOI: 10.4046/trd.2017.0123] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 01/16/2018] [Accepted: 02/20/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND We developed an additional laser guidance system to improve the efficacy and safety of conventional computed tomography (CT)-guided percutaneous transthoracic needle biopsy (PTNB), and we conducted this study to evaluate the efficacy and safety of our system. METHODS We retrospectively analyzed the medical records of 244 patients who underwent CT-guided PTNB using our additional laser guidance system from July 1, 2015, to January 20, 2016. RESULTS There were nine false-negative results among the 238 total cases. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of our system for diagnosing malignancy were 94.4% (152/161), 100% (77/77), 100% (152/152), 89.5% (77/86), and 96.2% (229/238), respectively. The results of univariate analysis showed that the risk factors for a false-negative result were male sex (p=0.029), a final diagnosis of malignancy (p=0.033), a lesion in the lower lobe (p=0.035), shorter distance from the skin to the target lesion (p=0.003), and shorter distance from the pleura to the target lesion (p=0.006). The overall complication rate was 30.5% (74/243). Pneumothorax, hemoptysis, and hemothorax occurred in 21.8% (53/243), 9.1% (22/243), and 1.6% (4/243) of cases, respectively. CONCLUSION The additional laser guidance system might be a highly economical and efficient method to improve the diagnostic efficacy and safety of conventional CT-guided PTNB even if performed by inexperienced pulmonologists.
Collapse
Affiliation(s)
- Min Cheol Jeon
- Department of Radiology, Daejeon Health Institute of Technology, Daejeon, Korea
| | - Ju Ock Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Sung Soo Jung
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Hee Sun Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Jeong Eun Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Jae Young Moon
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Chae Uk Chung
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Da Hyun Kang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Dong Il Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea.
| |
Collapse
|
18
|
Hwang EJ, Kim H, Park CM, Yoon SH, Lim HJ, Goo JM. Cone beam computed tomography virtual navigation-guided transthoracic biopsy of small (≤ 1 cm) pulmonary nodules: impact of nodule visibility during real-time fluoroscopy. Br J Radiol 2018; 91:20170805. [PMID: 29595322 DOI: 10.1259/bjr.20170805] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To evaluate the impact of nodule visibility during real-time fluoroscopy and other biopsy-related variables on the diagnostic accuracy and complication rates of cone beam CT (CBCT) virtual navigation (VN)-guided percutaneous transthoracic needle biopsies (PTNBs) of small (≤1 cm) pulmonary nodules. METHODS Patients (99 males and 114 females; age, 62.1 ± 11.1 years) who underwent CBCT VN-guided biopsies for lung nodules ≤ 1 cm were retrospectively reviewed. The visibility of target nodules was assessed on the captured fluoroscopy images. Diagnostic accuracies were calculated and logistic regression analyses were performed to determine independent influencing factors for the correct diagnosis and complications (pneumothoraxes and hemoptysis) in CBCT VN-guided PTNBs, respectively. RESULTS Among 213 nodules, 63 (29.6%) were invisible on real-time fluoroscopy during VN. The diagnostic accuracy of CBCT VN-guided PTNBs for the invisible nodules was 76.7%, while for the visible nodules was 89.1% (p = 0.042). In the logistic regression analysis, the visibility of a target nodule (odds ratio = 2.49, p = 0.047) was the only independent influencing factor for a correct diagnosis. As regards complication rates, nodule visibility was not a significant factor for the occurrence of a pneumothorax or hemoptysis. CONCLUSION Although nodule visibility on real-time fluoroscopy was an affecting factor for the correct diagnosis, CBCT VN-guided PTNB was feasible for the invisible nodules with diagnostic accuracy of 76.7%. Advance in knowledge: CBCT VN-guided PTNB can be tried safely for the subcentimeter-sized pulmonary nodules regardless of their fluoroscopic visibility.
Collapse
Affiliation(s)
- Eui Jin Hwang
- 1 Department of Radiology, Seoul National University College of Medicine , Seoul , Korea
| | - Hyungjin Kim
- 1 Department of Radiology, Seoul National University College of Medicine , Seoul , Korea
| | - Chang Min Park
- 1 Department of Radiology, Seoul National University College of Medicine , Seoul , Korea.,2 Institute of Radiation Medicine, Seoul National University Medical Research Center , Seoul , Korea
| | - Soon Ho Yoon
- 1 Department of Radiology, Seoul National University College of Medicine , Seoul , Korea.,2 Institute of Radiation Medicine, Seoul National University Medical Research Center , Seoul , Korea
| | - Hyun-Ju Lim
- 3 Department of Radiology, National Cancer Center , Goyang-si, Gyeonggi-do , Korea
| | - Jin Mo Goo
- 1 Department of Radiology, Seoul National University College of Medicine , Seoul , Korea.,2 Institute of Radiation Medicine, Seoul National University Medical Research Center , Seoul , Korea
| |
Collapse
|
19
|
Mills M, Choi J, El-Haddad G, Sweeney J, Biebel B, Robinson L, Antonia S, Kumar A, Kis B. Retrospective analysis of technical success rate and procedure-related complications of 867 percutaneous CT-guided needle biopsies of lung lesions. Clin Radiol 2017; 72:1038-1046. [DOI: 10.1016/j.crad.2017.07.023] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 07/20/2017] [Accepted: 07/31/2017] [Indexed: 01/05/2023]
|
20
|
Bhatt KM, Tandon YK, Graham R, Lau CT, Lempel JK, Azok JT, Mazzone PJ, Schneider E, Obuchowski NA, Bolen MA. Electromagnetic Navigational Bronchoscopy versus CT-guided Percutaneous Sampling of Peripheral Indeterminate Pulmonary Nodules: A Cohort Study. Radiology 2017; 286:1052-1061. [PMID: 29156147 DOI: 10.1148/radiol.2017170893] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Purpose To compare the diagnostic yield and complication rates of electromagnetic navigational bronchoscopic (ENB)-guided and computed tomography (CT)-guided percutaneous tissue sampling of lung nodules. Materials and Methods Retrospectively identified were 149 patients sampled percutaneously with CT guidance and 146 patients who underwent ENB with transbronchial biopsy of a lung lesion between 2013 and 2015. Clinical data, incidence of complications, and nodule pathologic analyses were assessed through electronic medical record review. Lung nodule characteristics were reviewed through direct image analysis. Molecular marker studies and pathologic analyses from surgical excision were reviewed when available. Multiple-variable logistic regression models were built to compare the diagnostic yield and complication rates for each method and for different patient and disease characteristics. Results CT-guided sampling was more likely to be diagnostic than ENB-guided biopsy (86.0% [129 of 150] vs 66.0% [99 of 150], respectively), and this difference remained significant even after adjustments were made for patient and nodule characteristics (P < .001). Age, American Society of Anesthesiologists class, emphysema grade, nodule size, and distance from pleura were not significant predictors of increased diagnostic yield. Intraprocedural time for physicians was significantly lower with CT-guided sampling (P < .001). Similar yield for molecular analyses was noted with the two approaches (ENB-guided sampling, 88.9% [32 of 36]; CT-guided sampling, 82.0% [41 of 50]). The two groups had similar rates of major complications (symptomatic hemorrhage, P > .999; pneumothorax requiring chest tube and/or admission, P = .417). Conclusion CT-guided transthoracic biopsy provided higher diagnostic yield in the assessment of peripheral pulmonary nodules than navigational bronchoscopy with a similar rate of clinically relevant complications. © RSNA, 2017 Online supplemental material is available for this article.
Collapse
Affiliation(s)
- Kavita M Bhatt
- From the Departments of Radiology (K.M.B., Y.K.T., R.G., C.T.L., J.K.L., J.T.A., E.S., M.A.B.), Pulmonology (P.J.M.), and Quantitative Health Sciences (N.A.O.), Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195
| | - Yasmeen K Tandon
- From the Departments of Radiology (K.M.B., Y.K.T., R.G., C.T.L., J.K.L., J.T.A., E.S., M.A.B.), Pulmonology (P.J.M.), and Quantitative Health Sciences (N.A.O.), Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195
| | - Ruffin Graham
- From the Departments of Radiology (K.M.B., Y.K.T., R.G., C.T.L., J.K.L., J.T.A., E.S., M.A.B.), Pulmonology (P.J.M.), and Quantitative Health Sciences (N.A.O.), Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195
| | - Charles T Lau
- From the Departments of Radiology (K.M.B., Y.K.T., R.G., C.T.L., J.K.L., J.T.A., E.S., M.A.B.), Pulmonology (P.J.M.), and Quantitative Health Sciences (N.A.O.), Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195
| | - Jason K Lempel
- From the Departments of Radiology (K.M.B., Y.K.T., R.G., C.T.L., J.K.L., J.T.A., E.S., M.A.B.), Pulmonology (P.J.M.), and Quantitative Health Sciences (N.A.O.), Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195
| | - Joseph T Azok
- From the Departments of Radiology (K.M.B., Y.K.T., R.G., C.T.L., J.K.L., J.T.A., E.S., M.A.B.), Pulmonology (P.J.M.), and Quantitative Health Sciences (N.A.O.), Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195
| | - Peter J Mazzone
- From the Departments of Radiology (K.M.B., Y.K.T., R.G., C.T.L., J.K.L., J.T.A., E.S., M.A.B.), Pulmonology (P.J.M.), and Quantitative Health Sciences (N.A.O.), Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195
| | - Erika Schneider
- From the Departments of Radiology (K.M.B., Y.K.T., R.G., C.T.L., J.K.L., J.T.A., E.S., M.A.B.), Pulmonology (P.J.M.), and Quantitative Health Sciences (N.A.O.), Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195
| | - Nancy A Obuchowski
- From the Departments of Radiology (K.M.B., Y.K.T., R.G., C.T.L., J.K.L., J.T.A., E.S., M.A.B.), Pulmonology (P.J.M.), and Quantitative Health Sciences (N.A.O.), Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195
| | - Michael A Bolen
- From the Departments of Radiology (K.M.B., Y.K.T., R.G., C.T.L., J.K.L., J.T.A., E.S., M.A.B.), Pulmonology (P.J.M.), and Quantitative Health Sciences (N.A.O.), Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195
| |
Collapse
|
21
|
Zhang HF, Liao MY, Zhu DY, Chen J, Wang YF. Lung radiodensity along the needle passage is a quantitative predictor of pneumothorax after CT-guided percutaneous core needle biopsy. Clin Radiol 2017; 73:319.e1-319.e7. [PMID: 29150082 DOI: 10.1016/j.crad.2017.10.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 10/05/2017] [Accepted: 10/12/2017] [Indexed: 11/29/2022]
Abstract
AIM To analyse whether the lowest value of lung radiodensity along the passage of the biopsy needle is a quantitative predictor of pneumothorax. MATERIALS AND METHODS CT-guided percutaneous core needle biopsy (PCNB) procedures performed at Zhongnan Hospital were analysed retrospectively. Age, gender, lesion size, lesion depth, lesion location, patient position, number of passages, needle pleural angle, pulmonary bleeding, and lung radiodensity along the needle passage were collected and classified by the extent of pneumothorax. Univariate analysis and multiple logistic regression analysis were assessed to explore the independent risk factors for pneumothorax. RESULTS Six hundred and seventy-seven cases were included in the study, including 456 males and 221 females. Pneumothorax occurred in 40.18% of cases, of which 82.4% were mild, 14% were moderate, and 3.7% were severe. Univariate and multivariate analysis showed that lesion size ≤2 cm (p=0.002), two or more passages (p=0.033), and lung radiodensity of -850 HU or less (p≤0.001) were independent risk factors for pneumothorax; bleeding (p<0.001) was a protective factor for pneumothorax. CONCLUSIONS The lowest value of lung radiodensity along the needle passage was a quantitative predictor of pneumothorax. A value of -850 HU or less was an independent risk factor for pneumothorax. As the value decreased, there was a higher risk of occurrence of more severe pneumothorax.
Collapse
Affiliation(s)
- H F Zhang
- Department of Radiology, Zhongnan Hospital of Wuhan University, China
| | - M Y Liao
- Department of Radiology, Zhongnan Hospital of Wuhan University, China.
| | - D Y Zhu
- Department of Radiology, Zhongnan Hospital of Wuhan University, China
| | - J Chen
- Department of Radiology, Zhongnan Hospital of Wuhan University, China
| | - Y F Wang
- Department of Radiology, Zhongnan Hospital of Wuhan University, China
| |
Collapse
|
22
|
Lendeckel D, Kromrey ML, Ittermann T, Schäfer S, Mensel B, Kühn JP. Pulmonary emphysema is a predictor of pneumothorax after CT-guided transthoracic pulmonary biopsies of pulmonary nodules. PLoS One 2017; 12:e0178078. [PMID: 28574995 PMCID: PMC5456052 DOI: 10.1371/journal.pone.0178078] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 05/06/2017] [Indexed: 12/02/2022] Open
Abstract
Purpose Pneumothoraces are the most frequently occurring complications of CT-guided percutaneous transthoracic pulmonary biopsies (PTPB). The aim of this study was to evaluate the influence of pre-diagnostic lung emphysema on the incidence and extent of pneumothoraces and to establish a risk stratification for the evaluation of the pre-procedure complication probability. Material and methods CT-guided PTPB of 100 pre-selected patients (mean age 67.1±12.8 years) were retrospectively enrolled from a single center database of 235 PTPB performed between 2012–2014. Patients were grouped according to pneumothorax appearance directly after PTPB (group I: without pneumothorax, n = 50; group II: with pneumothorax, n = 50). Group II was further divided according to post-interventional treatment (group IIa: chest tube placement, n = 24; group IIb: conservative therapy, n = 26). For each patient pre-diagnostic percentage of emphysema was quantified using CT density analysis. Emphysema stages were compared between groups using bivariate analyses and multinomial logistic regression analyses. Results Emphysema percentage was significantly associated with the occurrence of post-interventional pneumothorax (p = 0.006). Adjusted for potential confounders (age, gender, lesion size and length of interventional pathway) the study yielded an OR of 1.07 (p = 0.042). Absolute risk of pneumothorax increased from 43.4% at an emphysema rate of 5% to 73.8% at 25%. No differences could be seen in patients with pneumothorax between percentage of emphysema and mode of therapy (p = 0.721). Conclusion The rate of lung emphysema is proportionally related to the incidence of pneumothorax after CT-guided PTPB and allows pre-interventional risk stratification. There is no association between stage of emphysema and post-interventional requirement of chest tube placement.
Collapse
Affiliation(s)
- Derik Lendeckel
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Marie-Luise Kromrey
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
- * E-mail:
| | - Till Ittermann
- Institute of Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Sophia Schäfer
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Birger Mensel
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Jens-Peter Kühn
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
- Department of Radiology, Universitätsklinikum Dresden, Carl Gustav Carus University Dresden, Dresden, Germany
| |
Collapse
|
23
|
Abstract
BACKGROUND Image guided transthoracic needle aspiration (TTNA) is a valuable tool used for the diagnosis of countless thoracic diseases. Computed tomography (CT) is the most common imaging modality used for guidance followed by ultrasound (US) for lesions abutting the pleural surface. Novel approaches using virtual CT guidance have recently been introduced. The objective of this review is to examine the current literature for TTNA biopsy of the lung focusing on diagnostic accuracy and safety. METHODS MEDLINE was searched from inception to October 2015 for all case series examining image guided TTNA. Articles focusing on fluoroscopic guidance as well as influence of rapid on-site evaluation (ROSE) on yield were excluded. The diagnostic accuracy, defined as the number of true positives divided by the number of biopsies done, as well as the complication rate [pneumothorax (PTX), bleeding] was examined for CT guided TTNA, US guided TTNA as well as CT guided electromagnetic navigational-TTNA (E-TTNA). Of the 490 articles recovered 75 were included in our analysis. RESULTS The overall pooled diagnostic accuracy for CT guided TTNA using 48 articles that met the inclusion and exclusion criteria was 92.1% (9,567/10,383). A similar yield was obtained examining ten articles using US guided TTNA of 88.7% (446/503). E-TTNA, being a new modality, only had one pilot study citing a diagnostic accuracy of 83% (19/23). Pooled PTX and hemorrhage rates were 20.5% and 2.8% respectively for CT guided TTNA. The PTX rate was lower in US guided TTNA at a pooled rate of 4.4%. E-TTNA showed a similar rate of PTX at 20% with no incidence of bleeding in a single pilot study available. CONCLUSIONS Image guided TTNA is a safe and accurate modality for the biopsy of lung pathology. This study found similar yield and safety profiles with the three imaging modalities examined.
Collapse
Affiliation(s)
- David M DiBardino
- 1 Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA ; 2 Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Lonny B Yarmus
- 1 Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA ; 2 Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Roy W Semaan
- 1 Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA ; 2 Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| |
Collapse
|