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Improving the investigation of suspected respiratory disease
P181 Complications from CT guided lung biopsies and risk factors for pneumothorax
  1. Z Sheikh,
  2. E Woo,
  3. T Meagher
  1. Buckinghampshire Hopsital NHS Trust, Ayelsbury, UK

Abstract

Introduction and Objectives CT guided lung biopsy is a proven diagnostic method for lung cancer. However, traditionally complication rates from this procedure have been high. The aim of our study was to assess current complication rates from this procedure and the determine what possible risk factors may account for these.

Methods A retrospective cohort of CT guided lung biopsy procedures done between August 2008 and November 2010 were analysed. Patient notes and electronic radiology records (Centricity PACS) were reviewed. Complications of haemorrhage, pneumothorax, and death were recorded and the sample adequacy of biopsy specimens for pathological examination was determined for each procedure. A univariate analysis was performed for determining the risk of post-biopsy pneumothorax and biopsy type (core or FNA), number of co-axial needle passes, needle pleural angle, lesion size, and lesion distance from pleura at point of biopsy, and lesion location (lung or mediastinal). Consequently, a multiple logistic regression analysis was performed on the most significantly correlated risk factors for pneumothorax from the univariate analysis.

Results Exactly 200 biopsy procedures done in 184 patients were included of which 64% were core biopsies (n=128). The mean age was 69 years (range 31–90 years) with with 79.5% of patients over 65 years old (n=151) and 59.5% of patients male (n=119). Haemorrhage occurred in 2.5% (n=5) and pneumothorax in 17% (n=34) with 5% (n=10) of procedures requiring intercostals chest drain insertion for pneumothorax. No deaths were recorded. A statistically significant higher risk was observed for core biopsy (OR 3.65, p=0.00, 95% CI 1.38 to 9.65) and lesion distance from pleura >2 cm (OR 4.13, p<0.001, 95% CI 1.88 to 9.08). A multivariate analysis showed that the risk was greatest when core biopsies were taken from lesions more than 2 cm from the pleura at point of biopsy (OR 9.14, p<0.001, 95 % CI 2.72 to 30.69). The sample adequacy rate was 95.5% (n=191).

Conclusions In this recent study all complication rates were found to be lower than that reported in the national survey which is the current standard for BTS guidelines on acceptable complication rates. However, a higher rate of intercostal drain insertion was observed. Lesion distance from pleura at point of biopsy >2 cm and core biopsies were the most significant risk factors for post-biopsy pneumothorax and operators should consider these prior to biopsy. Larger studies are needed to reasses current national complication rates and target complication rates may need to be specified by biopsy type.

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