Transthoracic biopsy of lung masses: Non technical factors affecting complication occurrence

Frequency of complications and risk factors associated with computed tomography guided core needle lung biopsies

BACKGROUND

Although transthoracic needle biopsy (TTNB) is an effective method for diagnosis of lung tumors, it has some complications. It is crucial to know the frequency and severity of the complications of TTNB and its risk factors in order to avoid them.

OBJECTIVES

Evaluate the complications and risk factors of computed tomography guided core needle lung biopsies (CT-CNLB).

DESIGN

Prospective evaluation of complications.

SETTING

Single center in Turkey.

PATIENTS AND METHODS

For CT-CNLBs performed between October 2017 and March 2018, the complications of biopsies were noted and classified as major and minor based on guidelines of the Society of Interventional Radiology.

MAIN OUTCOME MEASURES

The complications and risk factors for complications were evaluated.

SAMPLE SIZE

123 adult patients.

RESULTS

The most common complications were pulmonary hemorrhage (30.9%) and pneumothorax (22%). Increased overall pulmonary hemorrhage was observed with underlying emphysema (P=.022), non-peripheral location of the lesion (P<.001), increased needle pathway (P<.001), fissure penetration (P=.011), increased number of pleura penetrations (P=.024), prolonged needle time across pleura (P=.037), and decreased lesion size (P=.033). The pneumothorax rate increased with non-peripheral location of the lesion (P<.007), fissure penetration (P=.021), prolonged needle time across the pleura (P=.013), and decreased lesion size (P=.002). In the logistic regression analyses for he two most common complications, the only risk factor for both alveolar hemorrhage and pneumothorax was a non-peripheral location of the lesion (P<.001, OR=14.7, 95% CI=3.9-55.4 for alveolar hemorrhage) and (P=.001, OR=156.2, 95% CI =7.34-3324.7 for pneumothorax).

CONCLUSION

Most common complications of CT-CNLB were pneumothorax and pulmonary alveolar hemorrhage with a 5.7% major complication rate. Choosing the shortest possible trans-pulmonary needle pathway minimizes the risk of complications.

LIMITATIONS

Limited number of patients, absence of rare complications as death, air embolism, and needle tract seeding.

CONFLICT OF INTEREST

None.

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

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.

Risk factors for hemoptysis complicating 17-18 gauge CT-guided transthoracic needle core biopsy: multivariate analysis of 249 procedures

PURPOSE

We aimed to identify modifiable and nonmodifiable risk factors for hemoptysis complicating computed tomography (CT)-guided transthoracic needle biopsy.

METHODS

All procedures performed in our institution from November 2013 to May 2015 were reviewed. Hemoptysis was classified as mild if limited to hemoptoic sputum and abundant otherwise. Presence of intra-alveolar hemorrhage on postbiopsy CT images was also evaluated. Patient- and lesion-related variables were considered nonmodifiable, while procedure-related variables were considered modifiable.

RESULTS

A total of 249 procedures were evaluated. Hemoptysis and alveolar hemorrhage occurred in 18% and 58% of procedures, respectively, and were abundant or significant in 8% and 17% of procedures, respectively. Concordance between the occurrence of significant alveolar hemorrhage (grade ≥2) and hemoptysis was poor (κ=0.28; 95% CI [0.16-0.40]). In multivariate analysis, female gender (P = 0.008), a longer transpulmonary needle path (P = 0.014), and smaller lesion size (P = 0.044) were independent risk factors for hemoptysis. Transpulmonary needle-path length was the only risk factor for abundant hemoptysis with borderline statistical significance (P = 0.049).

CONCLUSION

The transpulmonary needle path should be as short as possible to reduce the risk of abundant hemoptysis during CT-guided transthoracic needle biopsy.

Lung radiodensity along the needle passage is a quantitative predictor of pneumothorax after CT-guided percutaneous core needle biopsy

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.

Transthoracic Biopsy Causes Massive Subcutaneous Emphysema in a Low Risk Patient

Subcutaneous Emphysema (SE) can be defined as air leakage under skin from the respiratory or gastrointestinal system. It is frequently accompanied by pneumomediastinum. Thoracentesis, image-guided lung biopsies, pulmonary diseases and therapies resulting in necrosis can cause this pathology. The risk of pneumothorax and SE increased with the distance of the lesion to the pleura, and small size of the lesion. Although, our patient had low risk for SE, there were minimal pneumothoraces and massive SE. We consider that tumour necrosis and subcutaneous tissue may be related via transthoracic biopsy and this leads to massive SE.