Top

CardioVascular and Interventional Radiology

Published in:

01-09-2017 | Clinical Investigation

Is a Routine Chest X-ray Necessary in Every Patient After Percutaneous CT-Guided Lung Biopsy? A Retrospective Review of 278 Cases

Authors: Shayandokht Taleb, Hamed Jalaeian, Nickolas Frank, Jafar Golzarian, Donna D’Souza

Published in: CardioVascular and Interventional Radiology | Issue 9/2017

Abstract

Purpose

To determine the rate, clinical significance, and predictors of delayed pneumothorax after CT-guided lung biopsy.

Methods

Medical and imaging records of all patients who underwent CT-guided lung biopsy between January 1, 2012, and January 9, 2015, were reviewed. “Early pneumothorax” was defined as one visualized on CT scan at the time of biopsy, “delayed pneumothorax” as one discovered on the first follow-up chest X-ray (CXR), and “clinically significant pneumothorax” as one requiring chest tube placement.

Results

Three hundred fifty-seven lung biopsies were performed; 79 patients did not have follow-up CXR and were excluded. Out of 278 cases included in the study, early pneumothorax occurred in 109 patients. Follow-up CXRs were available in the remaining 169 patients without early pneumothorax and were obtained 3.1 ± 2.9 h after biopsy. The rate of delayed pneumothorax was 8.6% (24/278). Clinically significant pneumothorax occurred in 10/24 (41.7%) patients with delayed pneumothorax, including one case of tension pneumothorax. Patients with delayed pneumothorax (n = 24) had smaller lesion long axial diameter (18.58 ± 9.84 vs 25.83 ± 17.69 mm, p = 0.005), longer intrapulmonary needle tract (23.45 ± 14.98 vs 14.17 ± 14.49, p = 0.004), and lower FEV1/FVC ratio (53.30 ± 22.47 vs 71.15 ± 13.77, p = 0.015), compared to those without delayed pneumothorax (n = 145). The length of intrapulmonary needle tract was the only independent predictor of delayed pneumothorax (p = 0.008) and symptomatic delayed pneumothorax (p = 0.019).

Conclusion

Obtaining a routine follow-up CXR in all patients after CT-guided lung biopsy appears warranted, given the high rate of delayed pneumothorax and large percentage of patients who will require a chest tube. The only independent predictor of (symptomatic) delayed pneumothorax was the length of intrapulmonary needle tract.

Birchard KR. Transthoracic needle biopsy. Semin Intervent Radiol. 2011;28(1):87–97.CrossRefPubMedPubMedCentral

Boskovic T, Stanic J, Pena-Karan S, et al. Pneumothorax after transthoracic needle biopsy of lung lesions under CT guidance. J Thorac Dis. 2014;6(Suppl 1):S99–107.PubMedPubMedCentral

Byrd RP Jr, Fields-Ossorio C, Roy TM. Delayed chest radiographs and the diagnosis of pneumothorax following CT-guided fine needle aspiration of pulmonary lesions. Respir Med. 1999;93(6):379–81.CrossRefPubMed

Chiappetta M, Rosella F, Dall’armi V, et al. CT-guided fine-needle ago-biopsy of pulmonary nodules: predictive factors for diagnosis and pneumothorax occurrence. La Radiologia medica. 2016;121:635–43.CrossRefPubMed

Choi CM, Um SW, Yoo CG, et al. Incidence and risk factors of delayed pneumothorax after transthoracic needle biopsy of the lung. Chest. 2004;126(5):1516–21.CrossRefPubMed

Clayton JD, Elicker BM, Ordovas KG, Kohi MP, Nguyen J, Naeger DM. Nonclotted blood patch technique reduces pneumothorax and chest tube placement rates after percutaneous lung biopsies. J Thorac Imaging. 2016;31(4):243–6.CrossRefPubMed

Collings CL, Westcott JL, Banson NL, Lange RC. Pneumothorax and dependent versus nondependent patient position after needle biopsy of the lung. Radiology. 1999;210(1):59–64.CrossRefPubMed

Cox JE, Chiles C, McManus CM, Aquino SL, Choplin RH. Transthoracic needle aspiration biopsy: variables that affect risk of pneumothorax. Radiology. 1999;212(1):165–8.CrossRefPubMed

Dennie CJ, Matzinger FR, Marriner JR, Maziak DE. Transthoracic needle biopsy of the lung: results of early discharge in 506 outpatients. Radiology. 2001;219(1):247–51.CrossRefPubMed

10.

Despars JA, Sassoon CS, Light RW. Significance of iatrogenic pneumothoraces. Chest. 1994;105(4):1147–50.CrossRefPubMed

11.

Fish GD, Stanley JH, Miller KS, Schabel SI, Sutherland SE. Postbiopsy pneumothorax: estimating the risk by chest radiography and pulmonary function tests. AJR Am J Roentgenol. 1988;150(1):71–4.CrossRefPubMed

12.

Freund MC, Petersen J, Goder KC, Bunse T, Wiedermann F, Glodny B. Systemic air embolism during percutaneous core needle biopsy of the lung: frequency and risk factors. BMC Pulm Med. 2012;12:2.CrossRefPubMedPubMedCentral

13.

Halloush RA, Khasawneh FA, Saleh HA, Soubani AO, Piskorowski TJ, Al-Abbadi MA. Fine needle aspiration cytology of lung lesions: a clinicopathological and cytopathological review of 150 cases with emphasis on the relation between the number of passes and the incidence of pneumothorax. Cytopathology. 2007;18(1):44–51.CrossRefPubMed

14.

Heck SL, Blom P, Berstad A. Accuracy and complications in computed tomography fluoroscopy-guided needle biopsies of lung masses. Eur Radiol. 2006;16(6):1387–92.CrossRefPubMed

15.

Heerink WJ, de Bock GH, de Jonge GJ, Groen HJ, Vliegenthart R, Oudkerk M. Complication rates of CT-guided transthoracic lung biopsy: meta-analysis. Eur Radiol. 2016;27:138–48.CrossRefPubMedPubMedCentral

16.

Hirose T, Mori K, Machida S, Tominaga K, Yokoi K, Adachi M. Computed tomographic fluoroscopy-guided transthoracic needle biopsy for diagnosis of pulmonary nodules. Jpn J Clin Oncol. 2000;30(6):259–62.CrossRefPubMed

17.

Kazerooni EA, Lim FT, Mikhail A, Martinez FJ. Risk of pneumothorax in CT-guided transthoracic needle aspiration biopsy of the lung. Radiology. 1996;198(2):371–5.CrossRefPubMed

18.

Khan MF, Straub R, Moghaddam SR, et al. Variables affecting the risk of pneumothorax and intrapulmonal hemorrhage in CT-guided transthoracic biopsy. Eur Radiol. 2008;18(7):1356–63.CrossRefPubMed

19.

Kim JI, Park CM, Lee SM, Goo JM. Rapid needle-out patient-rollover approach after cone beam CT-guided lung biopsy: effect on pneumothorax rate in 1191 consecutive patients. Eur Radiol. 2015;25(7):1845–53.CrossRefPubMed

20.

Klein JS, Salomon G, Stewart EA. Transthoracic needle biopsy with a coaxially placed 20-gauge automated cutting needle: results in 122 patients. Radiology. 1996;198(3):715–20.CrossRefPubMed

21.

Kuban JD, Tam AL, Huang SY, et al. The effect of needle gauge on the risk of pneumothorax and chest tube placement after percutaneous computed tomographic (CT)-guided lung biopsy. Cardiovasc Intervent Radiol. 2015;38(6):1595–602.CrossRefPubMed

22.

Laurent F, Latrabe V, Vergier B, Michel P. Percutaneous CT-guided biopsy of the lung: comparison between aspiration and automated cutting needles using a coaxial technique. Cardiovasc Intervent Radiol. 2000;23(4):266–72.CrossRefPubMed

23.

MacDuff A, Arnold A, Harvey J, Group BTSPDG. Management of spontaneous pneumothorax: british thoracic society pleural disease guideline 2010. Thorax. 2010;65(Suppl 2):ii18–31.

24.

Manhire A, Charig M, Clelland C, et al. Guidelines for radiologically guided lung biopsy. Thorax. 2003;58(11):920–36.CrossRefPubMedPubMedCentral

25.

Ng YL, Patsios D, Roberts H, et al. CT-guided percutaneous fine-needle aspiration biopsy of pulmonary nodules measuring 10 mm or less. Clin Radiol. 2008;63(3):272–7.CrossRefPubMed

26.

Nour-Eldin NE, Alsubhi M, Emam A, et al. Pneumothorax complicating coaxial and non-coaxial ct-guided lung biopsy: comparative analysis of determining risk factors and management of pneumothorax in a retrospective review of 650 patients. Cardiovasc Intervent Radiol. 2016;39(2):261–70.CrossRefPubMed

27.

Richardson CM, Pointon KS, Manhire AR, Macfarlane JT. Percutaneous lung biopsies: a survey of UK practice based on 5444 biopsies. Br J Radiol. 2002;75(897):731–5.CrossRefPubMed

28.

Shantaveerappa HN, Mathai MG, Byrd RP Jr, Karnad AB, Mehta JB, Roy TM. Intervention in patients with pneumothorax immediately following CT-guided fine needle aspiration of pulmonary nodules. Med Sci Monit. 2002;8(6):CR401–4.PubMed

29.

Traill ZC, Gleeson FV. Delayed pneumothorax after CT-guided percutaneous fine needle aspiration lung biopsy. Thorax. 1997;52(6):581–2 discussion 575-586.CrossRefPubMedPubMedCentral

30.

Yeow KM, Su IH, Pan KT, et al. Risk factors of pneumothorax and bleeding: multivariate analysis of 660 CT-guided coaxial cutting needle lung biopsies. Chest. 2004;126(3):748–54.CrossRefPubMed

Title: Is a Routine Chest X-ray Necessary in Every Patient After Percutaneous CT-Guided Lung Biopsy? A Retrospective Review of 278 Cases
Authors: Shayandokht Taleb
Hamed Jalaeian
Nickolas Frank
Jafar Golzarian
Donna D’Souza
Publication date: 01-09-2017
Publisher: Springer US
Published in: CardioVascular and Interventional Radiology / Issue 9/2017
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI: https://doi.org/10.1007/s00270-017-1632-2

At a glance: The STEP trials

Springer Medicine

Is a Routine Chest X-ray Necessary in Every Patient After Percutaneous CT-Guided Lung Biopsy? A Retrospective Review of 278 Cases

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 9/2017

Authors’ Reply: Letter to the Editor Regarding “Yttrium-90 Radioembolization for Unresectable Combined Hepatocellular-Cholangiocarcinoma”

Psoas Abscess and Spondylodiscitis Following Radiofrequency Ablation of a Renal Tumour: Unexpected Complications

Image-Guided Transarterial Chemoembolization With Drug-Eluting Beads Loaded with Doxorubicin (DEBDOX) for Unresectable Hepatic Metastases from Melanoma: Technique and Outcomes

Adrenal Vein Sampling for Primary Aldosteronism: A 2-Week Protocol for Withdrawal of Renin-Stimulating Antihypertensives

Laser Recanalization of a Chronically Occluded Transjugular Intrahepatic Portosystemic Shunt (TIPS)

Microwave Ablation of Lung Tumors Near the Heart: A Retrospective Review of Short-Term Procedural Safety in Ten Patients