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01-11-2020 | Pneumothorax | Interventional

Dependent lesion positioning at CT-guided lung biopsy to reduce risk of pneumothorax

Authors: Elisabeth Appel, Sujithraj Dommaraju, Andrés Camacho, Masoud Nakhaei, Bettina Siewert, Muneeb Ahmed, Alexander Brook, Olga R. Brook

Published in: European Radiology | Issue 11/2020

Abstract

Objectives

To evaluate the impact of patient positioning during CT-guided lung biopsy on patients’ outcomes.

Methods

In this retrospective, IRB-approved, HIPAA-compliant study, consecutive CT-guided lung biopsies performed on 5/1/2015–12/26/2017 were included. Correlation between incidence of pneumothorax, chest tube placement, pulmonary bleeding with patient, and procedure characteristics was evaluated. Lesion-trachea-table angle (LTTA) was defined as an angle between the lesion, trachea, and horizontal line parallel to the table. Lesion above trachea has a positive LTTA. Univariate and multivariate logistic regression analysis was performed.

Results

A total of 423 biopsies in 409 patients (68 ± 11 years, 231/409, 56% female) were included in the study. Pneumothorax occurred in 83/423 (20%) biopsies with chest tube placed in 11/423 (3%) biopsies. Perilesional bleeding occurred in 194/423 (46%) biopsies and hemoptysis in 20/423 (5%) biopsies. Univariate analysis showed an association of pneumothorax with smaller lesions (p = 0.05), positive LTTA (p = 0.002), and lesions not attached to pleura (p = 0.026) with multivariate analysis showing lesion size and LTTA to be independent risk factors. Univariate analysis showed an association of increased pulmonary bleeding with smaller lesions (p < 0.001), no attachment to the pleura (p < 0.001), needle throw < 16 mm (p = 0.05), and a longer needle path (p < 0.001). Multivariate analysis showed lesion size, a longer needle path, and lesions not attached to the pleura to be independently associated with perilesional bleeding. Risk factors for hemoptysis were longer needle path (p = 0.002), no attachment to the pleura (p = 0.03), and female sex (p = 0.04).

Conclusions

Interventional radiologists can reduce the pneumothorax risk during the CT-guided biopsy by positioning the biopsy site below the trachea.

Key Points

• Positioning patient with lesion to be below the trachea for the CT-guided lung biopsy results in lower rate of pneumothorax, as compared with the lesion above the trachea.

• Positioning patient with lesion to be below the trachea for the CT-guided lung biopsy does not affect rate of procedure-associated pulmonary hemorrhage or hemoptysis.

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Title: Dependent lesion positioning at CT-guided lung biopsy to reduce risk of pneumothorax
Authors: Elisabeth Appel
Sujithraj Dommaraju
Andrés Camacho
Masoud Nakhaei
Bettina Siewert
Muneeb Ahmed
Alexander Brook
Olga R. Brook
Publication date: 01-11-2020
Publisher: Springer Berlin Heidelberg
Keywords: Pneumothorax
Hemoptysis
Pneumothorax
Pneumothorax
Pulmonary Hemorrhage
Hemoptysis
Published in: European Radiology / Issue 11/2020
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-020-07025-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Dependent lesion positioning at CT-guided lung biopsy to reduce risk of pneumothorax

Abstract

Objectives

Methods

Results

Conclusions

Key Points

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

Key Points

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