Chest
Volume 126, Issue 3, September 2004, Pages 748-754
Journal home page for Chest

Clinical Investigations
BRONCHOGENIC CARCINOMA
Risk Factors of Pneumothorax and Bleeding: Multivariate Analysis of 660 CT-Guided Coaxial Cutting Needle Lung Biopsies

https://doi.org/10.1378/chest.126.3.748Get rights and content

Background:

The results of studies identifying the risk factors for pneumothorax and bleeding in CT-guided coaxial lung needle biopsies were inconsistent and some were even contradictory. All reported series were small with patient populations averaging about 200.

Study objectives:

To determine the risk factors for pneumothorax and bleeding after CT-guided coaxial cutting needle biopsy of lung lesions.

Design:

Retrospective analysis.

Methods:

We reviewed 660 biopsy procedures. The risk factors for pneumothorax and bleeding were determined by multivariate analysis of variables related to patient demographics, lung lesions, biopsy procedures, and the individual radiologist.

Results:

The main complications were pneumothorax (23%; 155 of 660 procedures), chest tube insertion (1%; 9 of 660 procedures), and hemoptysis (4%; 26 of 660 procedures), with no patient mortality. The highest pneumothorax rate correlated with a lesion size of ≤ 2 cm, a lesion depth of 0.1 to 2 cm, and less experienced radiologists. The highest bleeding risk correlated with a lesion size ≤ 2 cm, a lesion depth of ≥ 2.1 cm, and the absence of pleural effusion.

Conclusions:

The risk factors for highest pneumothorax rate are lesion size ≤ 2 cm, a subpleural lesion depth of 0.1 to 2.0 cm, and a less experienced radiologist. The risk factors for highest bleeding rate are lesion size ≤ 2 cm, lesion depth ≥ 2.1 cm, and lung lesions not associated with a pleural effusion.

Section snippets

Study Population

From March 1995 to August 2001, a cohort of 660 consecutive CT-guided percutaneous coaxial cutting needle biopsies for focal lung lesions in 649 patients was subjected to a statistical analysis of the risk factors for pneumothorax and bleeding. Twelve patients underwent repeat biopsies. Repeat biopsies (10 patients had two biopsies, and 1 patient had three needle biopsies) were considered to be new procedures in the calculations, as variables selected were different in each procedure. There

Results

From initial univariate analyses, significant risk factors affecting the incidence of pneumothorax were lesion size (p < 0.001), lesion depth (p < 0.001), age (p = 0.003), emphysema seen on CT scan (p = 0.007), radiologists (p = 0.011), needle-pleural angle (p = 0.036), and chest wall thickness (p = 0.048), while significant risk factors affecting the incidence of pulmonary bleeding were lesion size (p < 0.001), lesion depth (p < 0.001), presence of pleural effusion (p < 0.001), chest wall

Discussion

In CT-guided coaxial cutting needle lung biopsy, the risk factors affecting pneumothorax rate are lesion size, lesion depth, and radiologist; and the risk factors affecting bleeding complication are lesion size, lesion depth, and the absence of pleural effusion. Our results show that the occurrences of pneumothorax and bleeding complications are independent of each other, so they are considered separately in the following discussion.

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