Top

Published in:

01-10-2016 | Interventional

Pneumothorax with prolonged chest tube requirement after CT-guided percutaneous lung biopsy: incidence and risk factors

Authors: Anna Moreland, Eitan Novogrodsky, Lynn Brody, Jeremy Durack, Joseph Erinjeri, George Getrajdman, Stephen Solomon, Hooman Yarmohammadi, Majid Maybody

Published in: European Radiology | Issue 10/2016

Abstract

Purpose

To evaluate the incidence and risk factors of pneumothoraces requiring prolonged maintenance of a chest tube following CT-guided percutaneous lung biopsy in a retrospective, single-centre case series.

Materials and methods

All patients undergoing CT-guided percutaneous lung biopsies between June 2012 and May 2014 who required chest tube insertion for symptomatic or enlarging pneumothoraces were identified. Based on chest tube dwell time, patients were divided into two groups: short term (0-2 days) or prolonged (3 or more days). The following risk factors were stratified between groups: patient demographics, target lesion characteristics, and procedural/periprocedural technique and outcomes.

Results

A total of 2337 patients underwent lung biopsy; 543 developed pneumothorax (23.2 %), 187 required chest tube placement (8.0 %), and 55 required a chest tube for 3 days or more (2.9 % of all biopsies, 29.9 % of all chest tubes). The median chest tube dwell time for short-term and prolonged groups was 1.0 days and 4.7 days, respectively. The transfissural needle path predicted prolonged chest tube requirement (OR: 2.5; p = 0.023). Other factors were not significantly different between groups.

Conclusion

Of patients undergoing CT-guided lung biopsy, 2.9 % required a chest tube for 3 or more days. Transfissural needle path during biopsy was a risk factor for prolonged chest tube requirement.

Key Points

• CT-guided percutaneous lung biopsy (CPLB) is an important method for diagnosing lung lesions

• A total of 2.9 % of patients require a chest tube for ≥3 days following CPLB

• Transfissural needle path is a risk factor for prolonged chest tube time

Hirose T, Mori K, Machida S, Tominaga K, Yokoi K, Adachi M (2000) Computed tomographic fluoroscopy-guided transthoracic needle biopsy for diagnosis of pulmonary nodules. Jpn J Clin Oncol 30:259–262CrossRefPubMed

Hur J, Lee HJ, Nam JE et al (2009) Diagnostic accuracy of CT fluoroscopy-guided needle aspiration biopsy of ground-glass opacity pulmonary lesions. AJR Am J Roentgenol 192:629–634CrossRefPubMed

Tuna T, Ozkaya S, Dirican A, Findik S, Atici AG, Erkan L (2013) Diagnostic efficacy of computed tomography-guided transthoracic needle aspiration and biopsy in patients with pulmonary disease. Onco Targets Ther 6:1553–1557PubMedPubMedCentral

Birchard KR (2011) Transthoracic needle biopsy. Semin Interv Radiol 28:87–97CrossRef

Ayyappan AP, Souza CA, Seely J, Peterson R, Dennie C, Matzinger F (2008) Ultrathin fine-needle aspiration biopsy of the lung with transfissural approach: does it increase the risk of pneumothorax? AJR Am J Roentgenol 191:1725–1729CrossRefPubMed

Sigel CS, Moreira AL, Travis WD et al (2011) Subtyping of non-small cell lung carcinoma: a comparison of small biopsy and cytology specimens. J Thorac Oncol 6:1849–1856CrossRefPubMed

Stewart CJ, Coldewey J, Stewart IS (2002) Comparison of fine needle aspiration cytology and needle core biopsy in the diagnosis of radiologically detected abdominal lesions. J Clin Pathol 55:93–97CrossRefPubMedPubMedCentral

Hiraki T, Mimura H, Gobara H et al (2010) Incidence of and risk factors for pneumothorax and chest tube placement after CT fluoroscopy-guided percutaneous lung biopsy: retrospective analysis of the procedures conducted over a 9-year period. AJR Am J Roentgenol 194:809–814CrossRefPubMed

Covey AM, Gandhi R, Brody LA, Getrajdman G, Thaler HT, Brown KT (2004) Factors associated with pneumothorax and pneumothorax requiring treatment after percutaneous lung biopsy in 443 consecutive patients. J Vasc Interv Radiol 15:479–483CrossRefPubMed

10.

Gupta S, Hicks ME, Wallace MJ, Ahrar K, Madoff DC, Murthy R (2008) Outpatient management of postbiopsy pneumothorax with small-caliber chest tubes: factors affecting the need for prolonged drainage and additional interventions. Cardiovasc Intervent Radiol 31:342–348CrossRefPubMed

11.

Perlmutt LM, Braun SD, Newman GE et al (1987) Transthoracic needle aspiration: use of a small chest tube to treat pneumothorax. AJR Am J Roentgenol 148:849–851CrossRefPubMed

12.

Nakamura M, Yoshizako T, Koyama S, Kitagaki H (2011) Risk factors influencing chest tube placement among patients with pneumothorax because of CT-guided needle biopsy of the lung. J Med Imaging Radiat Oncol 55:474–478CrossRefPubMed

13.

Lim CS, Tan LE, Wang JY et al (2014) Risk factors of pneumothorax after CT-guided coaxial cutting needle lung biopsy through aerated versus nonaerated lung. J Vasc Interv Radiol 25:1209–1217CrossRefPubMed

14.

Rizzo S, Preda L, Raimondi S et al (2011) Risk factors for complications of CT-guided lung biopsies. Radiol Med 116:548–563CrossRefPubMed

15.

Saji H, Nakamura H, Tsuchida T et al (2002) The incidence and the risk of pneumothorax and chest tube placement after percutaneous CT-guided lung biopsy: the angle of the needle trajectory is a novel predictor. Chest 121:1521–1526CrossRefPubMed

16.

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 229:475–481CrossRefPubMed

17.

Swischuk JL, Castaneda F, Patel JC et al (1998) Percutaneous transthoracic needle biopsy of the lung: review of 612 lesions. J Vasc Interv Radiol 9:347–352CrossRefPubMed

18.

Kazerooni EA, Lim FT, Mikhail A, Martinez FJ (1996) Risk of pneumothorax in CT-guided transthoracic needle aspiration biopsy of the lung. Radiology 198:371–375CrossRefPubMed

19.

Wu CC, Maher MM, Shepard JA (2011) Complications of CT-guided percutaneous needle biopsy of the chest: prevention and management. AJR Am J Roentgenol 196:W678–W682CrossRefPubMed

20.

Loiselle A, Parish JM, Wilkens JA, Jaroszewski DE (2013) Managing iatrogenic pneumothorax and chest tubes. J Hosp Med 8:402–408CrossRefPubMed

21.

Lokhandwala TDR, Johnson M, D'Souza AO (2014) Costs of the diagnostic workup for lung cancer— a medicare claims analysis. Int J Radiat Oncol Biol Phys. doi:10.1016/j.ijrobp.2014.08.142

22.

Brown KT, Brody LA, Getrajdman GI, Napp TE (1997) Outpatient treatment of iatrogenic pneumothorax after needle biopsy. Radiology 205:249–252CrossRefPubMed

23.

Moreira AL, Thornton RH (2012) Personalized medicine for non-small-cell lung cancer: implications of recent advances in tissue acquisition for molecular and histologic testing. Clin Lung Cancer 13:334–339CrossRefPubMed

24.

Johnson DH, Fehrenbacher L, Novotny WF et al (2004) Randomized phase II trial comparing bevacizumab plus carboplatin and paclitaxel with carboplatin and paclitaxel alone in previously untreated locally advanced or metastatic non-small-cell lung cancer. J Clin Oncol 22:2184–2191CrossRefPubMed

25.

Scagliotti GV, Parikh P, von Pawel J et al (2008) Phase III study comparing cisplatin plus gemcitabine with cisplatin plus pemetrexed in chemotherapy-naive patients with advanced-stage non-small-cell lung cancer. J Clin Oncol 26:3543–3551CrossRefPubMed

26.

Mok TS, Wu YL, Thongprasert S et al (2009) Gefitinib or carboplatin-paclitaxel in pulmonary adenocarcinoma. N Engl J Med 361:947–957CrossRefPubMed

27.

Wang ZJ, An TT, Mok T et al (2011) Immediate versus delayed treatment with egfr tyrosine kinase inhibitors after first-line therapy in advanced non-small-cell lung cancer. Chin J Cancer Res 23:112–117CrossRefPubMedPubMedCentral

28.

Eberhard DA, Johnson BE, Amler LC et al (2005) Mutations in the epidermal growth factor receptor and in KRAS are predictive and prognostic indicators in patients with non-small-cell lung cancer treated with chemotherapy alone and in combination with erlotinib. J Clin Oncol 23:5900–5909CrossRefPubMed

29.

Kwak EL, Bang YJ, Camidge DR et al (2010) Anaplastic lymphoma kinase inhibition in non-small-cell lung cancer. N Engl J Med 363:1693–1703CrossRefPubMedPubMedCentral

30.

Vatrella A, Galderisi A, Nicoletta C et al (2014) Age as a risk factor in the occurrence of pneumothorax after transthoracic fine needle biopsy: our experience. Int J Surg 12:S29–S32CrossRefPubMed

Title: Pneumothorax with prolonged chest tube requirement after CT-guided percutaneous lung biopsy: incidence and risk factors
Authors: Anna Moreland
Eitan Novogrodsky
Lynn Brody
Jeremy Durack
Joseph Erinjeri
George Getrajdman
Stephen Solomon
Hooman Yarmohammadi
Majid Maybody
Publication date: 01-10-2016
Publisher: Springer Berlin Heidelberg
Published in: European Radiology / Issue 10/2016
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-015-4200-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Pneumothorax with prolonged chest tube requirement after CT-guided percutaneous lung biopsy: incidence and risk factors

Abstract

Purpose

Materials and methods

Results

Conclusion

Key Points

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Materials and methods

Results

Conclusion

Key Points

Please log in to get access to this content

Other articles of this Issue 10/2016

Restaging oesophageal cancer after neoadjuvant therapy with 18F-FDG PET-CT: identifying interval metastases and predicting incurable disease at surgery

Effect of perioperative parecoxib sodium on postoperative pain control for transcatheter arterial chemoembolization for inoperable hepatocellular carcinoma: a prospective randomized trial

Quantification of deep medullary veins at 7 T brain MRI

Magnetic resonance imaging with gadoxetic acid for local tumour progression after radiofrequency ablation in patients with hepatocellular carcinoma

Regional thermochemotherapy versus hepatic arterial infusion chemotherapy for palliative treatment of advanced hilar cholangiocarcinoma: a retrospective controlled study

Tracheal CT morphology: correlation with distribution and extent of thoracic adipose tissue