Transthoracic needle biopsy: factors effecting risk of pneumothorax

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Abstract

Objective: to evaluate the factors that could effect the risk of pneumothorax in patients undergoing transthoracic biopsy. Material and methods: variables that could increase the risk of pneumothorax were evaluated in 453 CT-guided transthoracic biopsies. Factors were evaluated in two groups: (1) lesion related (presence of emphysema around the lesion, lesion depth, cavitation, presence of fissure/atelectasis and pleural tag in the needle trajectory); and (2) procedure related (biopsy type, needle size, number of passages, level of experience of the operator). All variables were analysed by χ2 test and multivariate logistic regression statistics. Results: pneumothorax was developed in 85 (18.8%) out of 453 procedures. A chest tube was inserted in ten (11.7%) of them. Variables that were significantly associated with an increased risk of pneumothorax were depth of the lesion (P<0.001) and severity of the emphysema (P<0.01). Conclusion: the length of the lung parenchyma traversed during the biopsy is the predominant risk factor for pneumothorax in patients undergoing CT-guided transthoracic biopsy. The risk of pneumothorax was also increased with the severity of the emphysema around the lesion.

Introduction

Percutaneous transthoracic biopsy of the lung is a well-established method for obtaining pulmonary tissue for pathologic examination. Pneumothorax is the most common complication of this procedure. The rate of pneumothorax reported in the literature ranges from 8 to 61% [1], [2], [3], [4], [5]. Pleural air resolves spontaneously in most of the patients without any intervention, however small number of patients may require chest tube insertion.

Recognizing the risk factors is important for allowing one to reduce or correct certain risks or to use alternative methods of diagnosis. The aim of this study is to evaluate the factors that influence development of pneumothorax.

Section snippets

Material and methods

Between 1999 and 2001, 453 CT-guided transthoracic biopsy were performed in 437 patients in our department. Before the procedure, CT examinations of the patients were evaluated and the most appropriate approach was decided. Selected slices were obtained within the area of interest with 3–10 mm slice thickness depending on the size of the lesion. Biopsies were planned to avoid fissures and bullae and the length of the lung parenchyma traversed would be the shortest. A compromise was made for

Results

In 437 patients 453 biopsies were performed. Of the patients 61 were female and 376 were male with the ages ranging between 16 and 87 (mean age=57). Pneumothorax occurred in 85 of procedures (18.8%). Chest tube placement was required in ten patients (11.7%).

The depth of the lesion was found to be the most significant variable (P<0.001). There were 233 lesions in direct contact with the pleura. Of those, pneumothorax developed in only 13 (4.2%). Table 1 shows the comparison of the frequency of

Discussion

In our study, pneumothorax rate was 18.8% with the 11.7% rate of chest tube insertion which correlated well with the previously reported rates. Prior investigators have reported that, a greater depth of the needle penetration from the pleural surface to the edge of the lesion was associated with a higher rate of pneumothorax [5], [6], [7], [8]. Our results support this conclusion. In our study, depth of the lesion was one of the most significant variable (P<0.001). While pneumothorax rate is

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