Abstract
The influence of various variables on the rate of pneumothorax and intrapulmonal hemorrhage associated with computed tomography (CT)-guided transthoracic needle biopsy of the lung were evaluated retrospectivly. One hundred and thirty-three patients underwent CT guided biopsy of a pulmonary lesion. Two patients were biopsied twice. Variables analyzed were lesion size, lesion location, number of pleural needle passes, lesion margin, length of intrapulmonal biopsy path and puncture time. Eighteen-gauge (18G) cutting needles (Trucut, Somatex, Teltow, Germany) were used for biopsy. Pneumothorax occured in 23 of 135 biopsies (17%). Chest tube placement was required in three out of 23 cases of pneumothorax (2% of all biopsies). Pneumothorax rate was significantly higher when the lesions were located in the lung parenchyma compared with locations at the pleura or chest wall (P < 0.05), but all pneumothorax cases which required chest tube treatment occured in lesions located less than 2 cm from the pleura. Longer puncture time led to an increase in pneumothorax rate (P < 0.05). Thirty-seven (27%) out of 135 biopsies showed perifocal hemorrhage. Intrapulmonal biopsy paths longer than 4 cm showed significantly higher numbers of perifocal hemorrhage and pneumothorax (P < 0.05). Significantly more hemorrhage occured when the pleura was penetrated twice during the puncture (P < 0.05). Lesion size <4 cm is strongly correlated with higher occurence of perifocal hemorrhage (P < 0.05). Lesion margination showed no significant effect on complication rate. CT-guided biopsy of smaller lesions correlates with a higher bleeding rate. Puncture time should be minimized to reduce pneumothorax rate. Passing the pleura twice significantly increases the risk of hemorrhage. Intrapulmonal biopsy paths longer than 4 cm showed significantly higher numbers of perifocal hemorrhage as well as pneumothorax.
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Abbreviations
- MDCT:
-
Multidetector Computed Tomography
References
Harter LP, Moss AA, Goldberg HI, Gross BH (1983) CT-guided fine-needle aspirations for diagnosis of benign and malignant disease. AJR Am J Roentgenol 140(2):363–367
Li H, Boiselle PM, Shepard JO, Trotman-Dickenson B, McLoud TC (1996) Diagnostic accuracy and safety of CT-guided percutaneous needle aspiration biopsy of the lung: comparison of small and large pulmonary nodules. AJR Am J Roentgenol 167(1):105–109
Perlmutt LM, Johnston WW, Dunnick NR (1989) Percutaneous transthoracic needle aspiration: a review. AJR Am J Roentgenol 152(3):451–455
Stanley JH, Fish GD, Andriole JG et al (1987) Lung lesions: cytologic diagnosis by fine-needle biopsy. Radiology 162(2):389–391
Westcott JL (1988) Percutaneous transthoracic needle biopsy. Radiology 169(3):593–601
Khouri NF, Stitik FP, Erozan YS et al (1985) Transthoracic needle aspiration biopsy of benign and malignant lung lesions. AJR Am J Roentgenol 144(2):281–288
Swischuk JL, Castaneda F, Patel JC et al (1998) Percutaneous transthoracic needle biopsy of the lung: review of 612 lesions. J Vasc Interv Radiol 9(2):347–352
Westcott JL, Rao N, Colley DP (1997) Transthoracic needle biopsy of small pulmonary nodules. Radiology 202(1):97–103
Laurent F, Latrabe V, Vergier B, Montaudon M, Vernejoux JM, Dubrez J (2000) CT-guided transthoracic needle biopsy of pulmonary nodules smaller than 20 mm: results with an automated 20-gauge coaxial cutting needle. Clin Radiol 55(4):281–287
Klein JS, Zarka MA (1997) Transthoracic needle biopsy: an overview. J Thorac Imaging 12(4):232–249
Klein JS, Salomon G, Stewart EA (1996) Transthoracic needle biopsy with a coaxially placed 20-gauge automated cutting needle: results in 122 patients. Radiology 198(3):715–720
Tsukada H, Satou T, Iwashima A, Souma T (2000) Diagnostic accuracy of CT-guided automated needle biopsy of lung nodules. AJR Am J Roentgenol 175(1):239–243
vanSonnenberg E, Lin AS, Deutsch AL, Mattrey RF (1983) Percutaneous biopsy of difficult mediastinal, hilar, and pulmonary lesions by computed tomographic guidance and a modified coaxial technique. Radiology 148(1):300–302
Larscheid RC, Thorpe PE, Scott WJ (1998) Percutaneous transthoracic needle aspiration biopsy: a comprehensive review of its current role in the diagnosis and treatment of lung tumors. Chest 114(3):704–709
Kazerooni EA, Lim FT, Mikhail A, Martinez FJ (1996) Risk of pneumothorax in CT-guided transthoracic needle aspiration biopsy of the lung. Radiology 198(2):371–375
Geraghty PR, Kee ST, McFarlane G, Razavi MK, Sze DY, Dake MD (2003) CT-guided transthoracic needle aspiration biopsy of pulmonary nodules: needle size and pneumothorax rate. Radiology 229(2):475–481
Cox JE, Chiles C, McManus CM, Aquino SL, Choplin RH (1999) Transthoracic needle aspiration biopsy: variables that affect risk of pneumothorax. Radiology 212(1):165–168
Laurent F, Michel P, Latrabe V, Tunon de Lara M, Marthan R (1999) Pneumothoraces and chest tube placement after CT-guided transthoracic lung biopsy using a coaxial technique: incidence and risk factors. AJR Am J Roentgenol 172(4):1049–1153
Yamagami T, Nakamura T, Iida S, Kato T, Nishimura T (2002) Management of pneumothorax after percutaneous CT-guided lung biopsy. Chest 121(4):1159–1164
Sinner WN (1976) Complications of percutaneous transthoracic needle aspiration biopsy. Acta Radiol Diagn (Stockh) 17(6):813–828
Muller NL, Bergin CJ, Miller RR, Ostrow DN (1986) Seeding of malignant cells into the needle track after lung and pleural biopsy. Can Assoc Radiol J 37(3):192–194
Graham RJ, Heyd RL, Raval VA, Barrett TF (1992) Lung torsion after percutaneous needle biopsy of lung. AJR Am J Roentgenol 159(1):35–37
Tolly TL, Feldmeier JE, Czarnecki D (1988) Air embolism complicating percutaneous lung biopsy. AJR Am J Roentgenol 150(3):555–556
Laurent F, Latrabe V, Vergier B, Michel P (2000) Percutaneous CT-guided biopsy of the lung: comparison between aspiration and automated cutting needles using a coaxial technique. Cardiovasc Intervent Radiol 23(4):266–272
Haramati LB, Austin JH (1991) Complications after CT-guided needle biopsy through aerated versus nonaerated lung. Radiology 181(3):778
Gupta S, Krishnamurthy S, Broemeling LD et al (2005) Small (</=2-cm) subpleural pulmonary lesions: short- versus long-needle-path CT-guided biopsy–comparison of diagnostic yields and complications. Radiology 234(2):631–637
Yeow KM, Su IH, Pan KT et al (2004) Risk factors of pneumothorax and bleeding: multivariate analysis of 660 CT-guided coaxial cutting needle lung biopsies. Chest 126(3):748–754
Fink I, Gamsu G, Harter LP (1982) CT-guided aspiration biopsy of the thorax. J Comput Assist Tomogr 6(5):958–962
Ohno Y, Hatabu H, Takenaka D et al (2003) CT-guided transthoracic needle aspiration biopsy of small (< or = 20 mm) solitary pulmonary nodules. AJR Am J Roentgenol 180(6):1665–1669
Moore EH, LeBlanc J, Montesi SA, Richardson ML, Shepard JA, McLoud TC (1991) Effect of patient positioning after needle aspiration lung biopsy. Radiology 181(2):385–387
Yeow KM, See LC, Lui KW et al (2001) Risk factors for pneumothorax and bleeding after CT-guided percutaneous coaxial cutting needle biopsy of lung lesions. J Vasc Interv Radiol 12(11):1305–1312
Wallace MJ, Krishnamurthy S, Broemeling LD et al (2002) CT-guided percutaneous fine-needle aspiration biopsy of small (< or =1-cm) pulmonary lesions. Radiology 225(3):823–828
Ko JP, Shepard JO, Drucker EA et al (2001) Factors influencing pneumothorax rate at lung biopsy: are dwell time and angle of pleural puncture contributing factors? Radiology 218(2):491–496
Kinoshita F, Kato T, Sugiura K et al (2006) CT-guided transthoracic needle biopsy using a puncture site-down positioning technique. AJR Am J Roentgenol 187(4):926–932
Topal U, Ediz B (2003) Transthoracic needle biopsy: factors effecting risk of pneumothorax. Eur J Radiol 48(3):263–267
Miller KS, Fish GB, Stanley JH, Schabel SI (1988) Prediction of pneumothorax rate in percutaneous needle aspiration of the lung. Chest 93(4):742–745
Fish GD, Stanley JH, Miller KS, Schabel SI, Sutherland SE (1988) Postbiopsy pneumothorax: estimating the risk by chest radiography and pulmonary function tests. AJR Am J Roentgenol 150(1):71–74
Poe RH, Kallay MC, Wicks CM, Odoroff CL (1984) Predicting risk of pneumothorax in needle biopsy of the lung. Chest 85(2):232–235
Topal U, Berkman YM (2005) Effect of needle tract bleeding on occurrence of pneumothorax after transthoracic needle biopsy. Eur J Radiol 53(3):495–499
Swensen SJ, Viggiano RW, Midthun DE et al (2000) Lung nodule enhancement at CT: multicenter study. Radiology 214(1):73–80
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Khan, M.F., Straub, R., Moghaddam, S.R. et al. Variables affecting the risk of pneumothorax and intrapulmonal hemorrhage in CT-guided transthoracic biopsy. Eur Radiol 18, 1356–1363 (2008). https://doi.org/10.1007/s00330-008-0893-1
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DOI: https://doi.org/10.1007/s00330-008-0893-1