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Abstract
Introduction CT-guided lung biopsy is a widely used and established technique for the diagnosis of lung lesions, and several risks are well described. The most common complication is pneumothorax, occurring in approximately 20% of cases. We aimed to characterise the risk of post-procedure pneumothorax in our patient population, and determine whether lung function indices correlate with the incidence of pneumothorax.
Methods Patients undergoing CT-guided biopsy of intraparenchymal lesions from January 2014–2015 were retrospectively identified. Patients were stratified in to those with and without post-procedure pneumothorax. Spirometry and transfer factor for carbon monoxide (TLCO) were reviewed and compared using an unpaired t test.
Results 111 procedures were performed in 111 patients (53 men 58 women; mean age 70.4 years; range 40 to 88), all done for suspected malignancy. Pneumothorax was identified in 25 patients post biopsy (21%; age range 61 to 87; mean ± SD age, 73.4 ± 6.7), 12 female (48%) and 9 patients (36%) had emphysema.
Of the 25 patients with pneumothorax, FEV1 ranged from 32 to 115% predicted (80.5% ± 23.57%) and FVC ranged from 54 to 125% (91.9% ± 19.1%). TLCO was available for 14 patients, range 34 to 99% predicted (71.5% ± 19.2%). Of the 86 patients with no pneumothorax, FEV1 ranged from 27 to 126% predicted (73.9% ± 29.9%) and FVC ranged from 38 to 139% predicted (85% ± 21.9%). TLCO was available for 50 patients (58%), range 31 to 108% predicted (63.2% ± 18.9%).
There was no significant difference in FEV1 (p = 0.199), FVC (p = 0.109), FEV1/FVC ratio (0.99) or TLCO (0.176) between the two groups.
In patients developing pneumothorax, those requiring a chest drain (6/25, 24%) showed no significant difference in FEV1 or FVC (p = 0.76 and p = 0.41 respectively) to those managed conservatively. TLCO however was significantly lower in patients requiring chest drain insertion (79% ± 16.1% vs. 52.8% ± 12.8%, p = 0.002).
Conclusion From our patient group, spirometry data and TLCO showed no correlation with the frequency of pneumothorax. In those patients developing pneumothorax, a low TLCO may predict the need for invasive management.