Risk factors for pneumothorax and bleeding after CT-guided percutaneous coaxial cutting needle biopsy of lung lesions.

PURPOSE: To evaluate risk factors for pneumothorax and bleeding after computed tomography (CT)-guided percutaneous coaxial cutting needle biopsy of lung lesions. MATERIALS AND METHODS: This study involved 117 consecutive patients with 117 intrapulmonary lesions. Statistical analysis of factors related to patient characteristics, lung lesions, and biopsy technique was performed to determine possible contribution to the occurrence of pneumothorax and bleeding. Interactions between related factors were considered to prevent colinearity. RESULTS: Pneumothorax occurred in 12% (14 of 117) of patients. Needle aspiration of two moderate asymptomatic pneumothoraces were performed; there was no chest tube insertion. Lesion depth (P =.0097), measured from the pleural puncture site to the edge of the intrapulmonary lesion along the needle path, was the single significant predictor of pneumothorax. The highest risk of pneumothorax occurred in subpleural lesions 2 cm or shorter in depth (this represented 33% of lung lesions but caused 71% of all pneumothoraces; OR = 7.1; 95% CI, 1.3-50.8). Bleeding presented as lung parenchyma hemorrhage and hemoptysis in 30 patients (26%). Hemoptysis occurred in four patients (3%). Univariate analysis identified lesion depth (P <.0001), lesion size (P <.015), and pathology type (P =.007) as risk factors for bleeding. Multivariate logistic regression analysis identified lesion depth as the most important risk factor, with the highest bleeding risk for lesions more than 2 cm deep (14% of lesions caused 46% of all bleeding; OR = 17.3; 95% CI, 3.3-121.4). CONCLUSIONS: In CT-guided coaxial cutting needle biopsy, lesion depth is the single predictor for risk of pneumothorax, which occurs at the highest rate in subpleural lesions. Increased risk of bleeding occurs in lesions deeper than 2 cm.     

CT-Guided Transthoracic Biopsy of Lung Lesions Using a Non-Coaxial Biopsy Needle Technique: CT Characteristics Predictive for Diagnostic Accuracy and Pneumothorax

Objectives:To analyze computed tomography (CT) characteristics predictive for diagnostic accuracy and pneumothorax in CT fluoroscopy-guided transthoracic biopsy (CTF-TTB) of lung lesions using non-coaxial biopsy needle technique.Methods:Retrospectively 274 lung lesion biopsies with confirmed histology were included in our study. CTF-TTB was done using an 18-gauge non-coaxial cutting needle. Diagnostic accuracy rates were calculated per lesion size and CT and procedural characteristics were evaluated for their predictive value regarding diagnostic accuracy and development of pneumothorax (maximal nodule diameter, distance to pleura, location per lung segment, nodule composition, benign versus malignant histology, and number of specimens).Results:Overall diagnostic accuracy of CTF-TTB was high (93%). Diagnostic accuracy for lesions ≤10 mm was 81%. Maximal nodule diameter was the only predictive CT characteristic for diagnostic success (p = 0.03). Pneumothorax occurred in 27%. Distance of lesion to pleura was the only risk factor for pneumothorax (p < 0.00001). Pneumothorax rates were significantly lower in subpleural lesions (14%) compared to those located 1–10 mm (47%), 10–20 mm (33%), and >20 mm from pleura (29%).Conclusions:High diagnostic accuracy rates were achieved with CTF-TTB using non-coaxial biopsy technique, even for lesions ≤10 mm. Pneumothorax rates were comparable with other studies. Lesion size was the only predictive CT characteristic for diagnostic accuracy. Distance to pleura was the only risk factor for pneumothorax.     

经皮肺穿刺气胸发生率分析

目的：分析了多种因素对肺穿刺活检气胸发生率的影响。方法46例病人均在X线透视引导下操作。所分析的各种因素为病灶大小、位置、穿刺次数、肺气肿及穿刺后体位。结果：46例病人中9例发生气胸（19．6％）,9例肺气肿病人中4例发生气胸（44．4％）,其中2例经胸腔置管引流治愈。10例病灶＜3cm者3例产生气胸（30％）。穿刺点向下卧位的20例中4例产生气胸（205）;剩余的26例自由卧位中5例产生气胸（19．2％）。结论：经皮肺穿活检中的病灶愈小气胸发生率愈高。肺气肿病人肺穿后气胸发生率较高,且常为症状性气胸。穿刺点向下及非向下卧位对气胸的发生率没有明显影响。     

Transthoracic needle aspiration biopsy: variables that affect risk of pneumothorax.

PURPOSE: To analyze the influence of multiple variables on the rate of pneumothorax and chest tube placement associated with transthoracic needle aspiration biopsy of the lung. MATERIALS AND METHODS: In 346 patients, 331 computed tomographically (CT) guided and 24 fluoroscopically guided lung biopsies were performed. Variables analyzed were lesion size, depth, and location; number of pleural passes; needle size; presence of emphysema; and training level of the person who performed the biopsy. RESULTS: Pneumothorax occurred at 144 (40.4%) of 356 biopsies, including 139 (42.0%) CT-guided and five (21%) fluoroscopically guided biopsies. Chest tube placement was needed in 25 (17.4%) of 144 cases of pneumothorax (7% of all biopsies). An increased rate of pneumothorax was correlated with smaller lesion size (P = .001) and presence of emphysema (P = .01). Patients with emphysema were three times as likely to require chest tube placement. The pneumothorax rate was 15% (16 of 105) if no aerated lung was traversed and approximately 50% if aerated lung was penetrated. Lesion location, needle size, number of pleural passes, and level of training were not correlated with pneumothorax rate. CONCLUSION: Smaller lesion size and emphysema are strongly correlated with occurrence of pneumothorax. Pneumothorax was more than three times less frequent if no aerated lung was traversed. After pneumothorax, chest tube placements were related to the presence of emphysema.     

Computed tomography-navigated transthoracic core biopsy of pulmonary lesions: which factors affect diagnostic yield and complication rates?

RATIONALE AND OBJECTIVES: Only a few studies have systematically evaluated risk factors for pneumothorax and pulmonary hemorrhage in computed tomographically (CT)-guided transthoracic lung biopsy (TLB). We evaluated the diagnostic yield of CT-guided TLB and determined risk factors for pneumothorax and hemorrhage. METHODS: One hundred seventy-two CT-guided TLBs were performed on 159 patients (mean age 66 +/- 11 years; 72% male) using a 16-gauge core biopsy needle. Lesion and patient characteristics, lung function analysis, CT signs of emphysema, histopathologic diagnoses, and complications were recorded. Statistical analysis was performed with multivariate regression analysis. RESULTS: Histopathologic diagnosis was established in 153 cases (89%). Although lesion size was higher (47 +/- 29 vs. 43 +/- 35 mm, P = .191) and depth was lower (22 +/- 23 vs. 6 +/- 23 mm, P = .350) in procedures with histopathologic diagnosis, no parameter showed significant impact on diagnostic yield. Sensitivity and specificity for detection of malignancy were 93% and 100%, respectively, whereas positive and negative predictive values were 100% and 88%. Overall accuracy was 95%. Pneumothorax occurred in 45 procedures (26%). Hemorrhage was recorded in 17 procedures (10%). There was higher frequency of pneumothorax in smaller lesions (35 +/- 23 vs. 50 +/- 31 mm, P = .003; odds ratio = .96) and greater depth (29 +/- 29 vs. 20 +/- 19 mm, P = .05; odds ratio = 1.03). CT signs of emphysema revealed higher incidence of hemorrhage (35% vs. 23%; P = .04; odds ratio=41.03). Other parameters were nonsignificant. CONCLUSIONS: The high diagnostic yield of CT-guided TLB was not affected by lesion characteristics or emphysema. Pneumothorax rate was influenced by lesion size and depth. Hemorrhage was associated with CT signs of emphysema.     

Factors influencing pneumothorax rate at lung biopsy: are dwell time and angle of pleural puncture contributing factors?

PURPOSE: To study factors that may influence pneumothorax and chest tube placement rate, especially needle dwell time and pleural puncture angle. MATERIALS AND METHODS: In 159 patients, 160 coaxial computed tomography (CT)-guided lung biopsies were performed. Dwell time, the time between pleural puncture and needle removal, was calculated. The smallest angle of the needle with the pleura ("needle-pleural angle") was measured. These and other variables were correlated with pneumothorax and chest tube rates. RESULTS: One hundred fifty biopsies were included. There were 58 (39%) pneumothoraces (14 noted only at CT), with eight (5%) biopsies resulting in chest tube placement. Longer dwell times (mean, 29 minutes; range, 12-66 minutes) did not correlate with pneumothoraces (P =.81). Smaller needle-pleural angles (< 80 degrees) [corrected], decreased forced expiratory volume in 1 second to vital capacity ratio (<50%), lateral pleural puncture, and lesions along fissures were associated with higher [corrected] pneumothorax rates (P <.05). Emphysema along the needle path, pulmonary function tests showing ventilatory obstruction, and lesions along fissures predisposed patients to chest tube placement (P <.05). Pleural thickening and prior surgery were associated with lower pneumothorax rates (P <.05). CONCLUSION: Longer dwell times do not correlate with pneumothorax and should not influence the decision to obtain more biopsy samples. A shallow pleural puncture angle may increase the pneumothorax rate.     

CT-guided cutting needle lung biopsy using modified coaxial technique: factors effecting risk of complications

Purpose

We present our 7-year experience with coaxial computed tomography (CT)-guided cutting needle lung biopsy and evaluate the factors affecting risk of complications.

Material and method

Between June 2000 and March 2007, we performed 225 CT-guided coaxial lung biopsies in 213 consecutive patients (161 men, 52 women). Lesion size, lesion depth, lesion location, needle-pleural angle, presence of pleural effusion, patient's position, and complications secondary to biopsy procedure (pneumothorax and bleeding) were noted. Pneumothorax was graded as mild, moderate, and severe. Bleeding complications were graded as mild, moderate, and severe.

Results

Two hundred twenty-five biopsy procedures were performed in 213 patients. The mean diameter of the lung lesion was 41.3 ± 20.1 mm. The mean distance from the peripheral margin of the lesion to the pleura was 17.3 ± 19.2 mm. After 225 procedures, there were 42 mild (18.6%), 13 moderate (5.7%), and 4 severe (1.7%) pneumothoraxes. Small hemoptysis occurred in 27 patients (12%), and mild parenchymal hemorrhage occurred in 2 patients (0.8%). The overall complication rate was 39.1%. Although, a statistically significant correlation was found between female sex, presence of emphysema, lesion depth, and pneumothorax, none of these factors had a predictive value for pneumothorax. Although, statistically significant correlations were found between female sex, lesion size, and bleeding, only lesion size had a predictive value for bleeding.

Conclusion

The most frequent and important complications of this procedure are pneumothorax and bleeding. But any factor is the predictor of pneumothorax and lesion depth is a poor predictor of bleeding complication.     

Transthoracic fine-needle aspiration biopsy of the lungs using a C-arm cone-beam CT system: diagnostic accuracy and post-procedural complications

Objective: The purpose of our study was to evaluate the diagnostic accuracy of transthoracic fine-needle aspiration biopsy (TFNAB) using a C-arm cone-beam CT (CBCT) system and to assess risk factors for immediate post-procedural complications in patients with lung lesions. Methods: From October 2007 to April 2009, 94 TFNAB procedures using a C-arm system were studied in 91 patients with pulmonary lesions a chest CT scans. We retrospectively reviewed the patients' radiological and histopathological findings. We evaluated the lesion size, lesion abutted to pleura and presence or absence of emphysema along the needle path, lesion depth, visibility of target lesion and patient's position. Pneumothorax and pulmonary haemorrhage were assessed after TFNAB. Overall diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were analysed. Results: In 94 TFNAB procedures, 58 lesions were malignant and 36 were benign. The sensitivity, specificity, PPV, NPV and overall diagnostic accuracy rate of TFNAB were 93.1%, 100%, 100%, 90% and 97.9%, respectively. Pneumothorax was developed in 24 procedures. None of the parameters showed significant impact on the frequency of the pneumothorax. Overall haemorrhage occurred in 43 procedures. The incidence of overall haemorrhage was higher in patients with smaller lesions, longer pleural distance and pleural abutted lesions (p<0.05). Differences in visibility at projection radiographs were statistically significant between patients with or without perilesional haemorrhage (p<0.05). Conclusion: Transthoracic fine-needle aspiration biopsy using a C-arm CBCT system is feasible for imaging guidance of lung lesion and early detection of the procedural-related complications.     

病灶因素对CT导向下经皮肺穿刺活检并发症发生率的影响

目的:探讨CT导向下经皮肺穿刺活检并发症发生率与病灶大小、深度和部位之间的关系。方法:复习CT导向下肺部病变穿刺活检184例,所有病灶按大小分为≥3cm(122个)和<3cm(62个)两组,按病灶深度分为≥2cm(98个)和<2cm(86个)两组,按病灶部位分为上肺野(28个)、中肺野(61个)和下肺野(95个)3组,分别统计各组的并发症发生率。结果:直径<3cm病灶的并发症发生率(气胸19.23%,出血44.19%)明显高于≥3cm病灶(气胸5.17%,出血15.09%,P<0.05);深度≥2cm病灶的并发症发生率(气胸13.27%,出血25.51%)显著高于<2cm者(气胸3.49%,出血11.63%,P<0.05);不同肺野病灶的并发症发生率之间差异无显著性意义(P>0.05)。结论:病灶大小和深度是影响CT导向下经皮肺穿刺活检并发症发生率的主要因素。     

CT引导下经皮肺穿刺活检并发症的相关因素分析

目的:分析引起CT引导下经皮肺穿刺活检并发症发生的相关因素.方法:选取2003年10月～2005年9月CT引导下肺穿刺活检的病例284例,分析穿刺并发症的发生与性别、年龄、病灶大小、深度、病灶周围有无肺气肿、穿刺次数、穿刺针粗细等的关系,并进行统计分析.结果:共发生气胸26例,出血(包括肺内出血和针道出血)48例.并发症的发生与病灶大小、深度、病灶周围有无肺气肿、穿刺次数、穿刺针粗细及年龄有关(P＜0.05).结论:CT引导下经皮肺穿刺活检常见并发症有气胸和出血.病灶大小、深度、病灶周围肺气肿、穿刺次数、穿刺针粗细以及年龄是肺穿刺活检并发症的相关因素.     

Transthoracic CT-guided biopsy with multiplanar reconstruction image improves diagnostic accuracy of solitary pulmonary nodules

OBJECTIVE: To evaluate the utility of multiplanar reconstruction (MPR) image for CT-guided biopsy and determine factors of influencing diagnostic accuracy and the pneumothorax rate. MATERIALS AND METHODS: 390 patients with 396 pulmonary nodules underwent transthoracic CT-guided aspiration biopsy (TNAB) and transthoracic CT-guided cutting needle core biopsy (TCNB) as follows: 250 solitary pulmonary nodules (SPNs) underwent conventional CT-guided biopsy (conventional method), 81 underwent CT-fluoroscopic biopsy (CT-fluoroscopic method) and 65 underwent conventional CT-guided biopsy in combination with MPR image (MPR method). Success rate, overall diagnostic accuracy, pneumothorax rate and total procedure time were compared in each method. Factors affecting diagnostic accuracy and pneumothorax rate of CT-guided biopsy were statistically evaluated. RESULTS: Success rates (TNAB: 100.0%, TCNB: 100.0%) and overall diagnostic accuracies (TNAB: 96.9%, TCNB: 97.0%) of MPR were significantly higher than those using the conventional method (TNAB: 87.6 and 82.4%, TCNB: 86.3 and 81.3%) (P < 0.05). Diagnostic accuracy were influenced by biopsy method, lesion size, and needle path length (P < 0.05). Pneumothorax rate was influenced by pathological diagnostic method, lesion size, number of punctures and FEV1.0% (P < 0.05). CONCLUSION: The use of MPR for CT-guided lung biopsy is useful for improving diagnostic accuracy with no significant increase in pneumothorax rate or total procedure time.     

Effect of needle tract bleeding on occurrence of pneumothorax after transthoracic needle biopsy

PURPOSE: Occasionally bleeding along the needle trajectory is observed at post-biopsy computed tomographic sections. This study was designed to evaluate the possible effect of needle tract bleeding on the occurrence of pneumothorax and on requirement of chest tube insertion. MATERIALS AND METHODS: Two hundred eighty-four needle biopsies performed in 275 patients in whom the needle traversed the aerated lung parenchyma were retrospectively reviewed. Bleeding along the needle tract, occurrence of pneumothorax and need for chest tube insertion, type and size of the needle, size of the lesion, length of the lung traversed by the needle, presence or absence of emphysema were noted. Effect of these factors on the rate of pneumothorax and needle-tract bleeding was evaluated. The data were analyzed by chi2 test. RESULTS: Pneumothorax developed in 100 (35%) out of 284 procedures requiring chest tube placement in 16 (16%). Variables that were significantly associated with an increased risk of pneumothorax were depth of the lesion (P < 0.001) and severity of emphysema (P < 0.05). There was bleeding along the needle tract in 18.6% (n = 53) of the procedures. Pneumothorax occurred in 18 (33.9%) out of 53 procedures in which tract-bleeding was observed and in 82 (35.4%) out of 231 procedures in which tract-bleeding was not seen. The difference between the two groups was not significant (P > 0.05). However, analysis of the relation between length of lung traversed by the needle, tract-bleeding and pneumothorax rate indicated that tract-bleeding had a preventive effect on development of pneumothorax (P < 0.001). Occurrence of tract bleeding also had preventive effect on pneumothorax in the presence of emphysema (P < 0.05). The only variable which had effect on occurrence of tract-bleeding was the length of the lung traversed by needle (p < 0.001). Requirement for chest tube insertion was smaller in the tract-bleeding group than non-tract bleeding group, 11% (2/18) to 17% (14/82), respectively. But this difference was not significant statistically (P > 0.05). CONCLUSION: Bleeding in the needle tract has a preventive effect on the occurrence of the pneumothorax in deep-seated lesions and in the presence of emphysema, although it does not affect the overall rate of pneumothorax.     

CT fluoroscopy guided transpleural cutting needle biopsy of small (≤2.5 cm) subpleural pulmonary nodules

Purpose

Small subpleural pulmonary lesions are difficult to biopsy. While the direct, short needle path has been reported to have a lower rate of pneumothorax, the indirect path provides a higher diagnostic yield. Therefore, we tried to optimize the needle pathway and minimize the iatrogenic pneumothorax risk by evaluating a CT fluoroscopy guided direct approach to biopsy subpleural lesions.

Material and methods

Between 01/2005 and 01/2007, CT fluoroscopy guided core biopsies were performed in 24 patients. Using our technique, the tip of the guide needle remains outside the visceral pleura (17 G coaxial guide needle, 18 G Biopsy-gun, 15 or 22 mm needle path). The position of the lesion relative to the needle tip can be optimized using CT fluoroscopy by adjusting the breathing position of the patient. The Biopty gun is fired with the needle tip still outside the pleural space. Cytological smears are analyzed by a cytopathologist on-site, and biopsies are repeated as indicated with the coaxial needle still outside the pleura.

Results

Median nodule size was 1.6 cm (0.7-2.3 cm). A definitive diagnosis was obtained in 22 patients by histology and/or cytology. In one patient, only necrotic material could be obtained. In another patient, the intervention had to be aborted as the dyspnoic patient could not follow breathing instructions. An asymptomatic pneumothorax was present in seven patients; chest tube placement was not required.

Conclusion

The presented biopsy approach has a high diagnostic yield and is especially advantageous for biopsies of small subpleural lesions in the lower lobes.     

Pneumothoraces and chest tube placement after CT-guided transthoracic lung biopsy using a coaxial technique: incidence and risk factors

OBJECTIVE: This study investigates factors influencing the risk of pneumothorax and chest tube placement in patients undergoing CT-guided transthoracic lung biopsy for pulmonary lesions using a coaxial technique. SUBJECTS AND METHODS: The study included 307 patients with pulmonary lesions biopsied under CT guidance. Patient-related parameters considered were age, sex, presence of emphysema or bullae, and lung function data. Lesion-related variables were size, location, cavitary appearance on CT, pleural contact, and depth of the lesion. Procedure variables were duration, type of needle, and experience of the operator. All variables were analyzed as single and multiple dependent variables for occurrence of pneumothorax. RESULTS: Pneumothorax occurred in 61 (19.9%) of the 307 patients, and chest tube placement was required in six patients (2.0%). Univariate analysis showed that lesion size, lesion location, lesion depth, and difficulty of the procedure were significantly associated with a higher rate of pneumothorax. Using multivariate logistic regression analysis, we found that lesion depth from the pleural entry point was the sole variable that was significantly associated with an increased risk of pneumothorax. This risk increased with the depth of the lesion. Chest tube placement was required more frequently in patients with severe emphysema, obstructive lung disease, or hyperinflation. CONCLUSION: Lesion depth is the predominant risk factor for pneumothorax in patients undergoing CT-guided transthoracic lung biopsy. Chest tube placement is necessary more frequently in patients with severe emphysema, obstructive lung disease, or hyperinflation.     

Breath-hold after forced expiration before removal of the biopsy needle decreased the rate of pneumothorax in CT-guided transthoracic lung biopsy

Purpose

To assess the effect of a breath-hold after forced expiration on the rate of pneumothorax after computed tomography (CT)-guided transthoracic needle biopsy of pulmonary lesions.

Materials and methods

Between January 2008 and December 2011, percutaneous CT-guided lung biopsy was performed in 440 patients. Two hundred and twenty-one biopsies were performed without (control group) and two hundred and nineteen biopsies were performed with (study group) the study maneuver – a breath-hold after forced expiratory approach. Multivariate analysis was performed between groups for risk factors for pneumothorax, including patient demographics, lesion characteristics, and biopsy technique.

Results

A reduced number of pneumothoraces (18 [8.2%] vs 35 [15.8%]; P = 0.014) but no significant difference in rate of drainage catheter insertions (2 [0.9%] vs (4 [1.8%]; P = 0.418) were noted in the study group as compared with the control group. By logistic regression analysis, three factors significantly and independently affected the risk for pneumothorax including lesion size (transverse and longitudinal diameter), distance from pleura and utilizing or avoiding the breath-hold after deep expiration maneuver.

Conclusion

Breath-holding after forced expiration before removal of the biopsy needle during the percutaneous CT-guided transthoracic lung biopsy almost halved the rate of overall pneumothorax. Small lesion size (longitudinal diameter) and the distance from pleura were also predictors of pneumothorax in our study.     

胸膜外定位法CT导引下经肺穿刺活检

目的 探讨胸膜外定位(EPL)法行CT导引下经肺穿刺活检,在减少气胸发生率和气胸量方面的应用价值.方法 选取行CT导引下肺穿刺活检中肺内病变与相邻胸膜不接触的患者共115例,根据定位方法的不同,分为EPL组46例、病灶边缘定位(EEL)组69例,两组患者又根据病变外缘沿穿刺方向与胸壁内缘的距离分为近距组(距离≤2era)和远距组(距离>2cm),对比两组患者气胸发生率与气胸量,并进行行×列表X2检验.分别记录并计算两组活检针在肺内的滞留时间及其平均值.结果 EPL组气胸发生率为45.7%(21/46),脏壁层胸膜最大距离0.2～2.5cm,中位数0.4cm;IZL组气胸发生率为66.7%(46/69),脏壁层胸膜最大距离0.2～9.0cm,中位数0.3cm.病灶与胸膜距离≤2cm时,EPL组气胸发生率为39.4%(13/33);LEL组气胸发生率为73.2%(30/41),两组差异有统计学意义(X2=9.981,P=0.019).病灶与胸膜距离>2cm时,EPL组气胸发生率略低于LEL,但两组差异无统计学意义.EPL组活检针在肺内的滞留时间为(7.2±1.8)s,LEL组为(58.3±11.6)s.结论 EPL法CT导引下肺穿刺活检能明显缩短活检针在肺内的滞留时间,减少气胸发生率及产生的气胸量,具有一定价值,是一种值得推广的新方法.     

肺穿刺活检肺组织出血和发生气胸相互关系的探讨

目的 探讨肺活检中肺组织出血和发生气胸两者间的关系.资料与方法 选用18G半自动槽式切割活检针,CT定位下经皮经肺穿刺取材进行细胞学、组织学检查.结果 168例中发生气胸63例,占37.5%;肺组织出血76例,占45.2%.肺出血与气胸组发生例数呈明显负相关(P< 0.01);针道周围肺组织出血患者的气胸发生率减少(P<0.05).结论 肺穿刺活检发生针道周围肺组织出血能降低气胸的发生.     

Diagnostic accuracy and complication rates of percutaneous CT-guided coaxial needle biopsy of pulmonary lesions

PURPOSEThe aim of this retrospective study was to evaluate and compare diagnostic accuracy and complication rates of percutaneous computed tomography (CT)-guided biopsies of pulmonary lesions 10–35 mm, 35–50 mm, and >50 mm, using the coaxial biopsy technique.METHODSOver a 4-year period, 235 lung biopsies were performed using the coaxial biopsy technique with 18G semi-automated true-cut needle. There were 163 (69.4%) male and 72 (30.6%) female patients, with a mean age of 64.01±9.18 years (18–85 years). The mean lesion size was 59.6±29.3 mm. The lesions were stratified into three groups according to size: lesions <35 mm (n=42, 17.9%), lesions 35–50 mm (n=53, 22.5%), and lesions >50 mm (n=140, 59.6%). Diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for all biopsies, and for each group separately, as well as the incidence of complications.RESULTSThe overall diagnostic accuracy was 95.4%, with 95.52% sensitivity, 100% specificity, 100% PPV, and 47.37% NPV. For lesions <35 mm, diagnostic accuracy, sensitivity, and PPV were 100%. The lowest diagnostic accuracy was 93.9% in lesions >50 mm, with 93.65% sensitivity, 100% specificity, 100% PPV, and 42.86% NPV. An adequate sample was obtained in 219 core biopsies (93.2%), while 16 biopsies (6.8%) were nondiagnostic due to necrosis (4.25%) and insufficient biopsy material (2.55%). The most frequent complication was minor pneumothorax, which was seen at a rate of 19.1%; pneumothorax requiring chest tube placement occurred in 3 patients (1.3%).CONCLUSIONDiagnostic accuracy decreased with increasing lesion size. On the other hand, complication rates were higher in smaller lesions, more distanced from the pleura.

Computed tomography (CT)-guided percutaneous needle biopsy is a well-established method in the diagnostic algorithm of various pulmonary lesions, with two types of biopsy techniques employed, fine-needle aspiration biopsy (FNAB) and core biopsy (CB). Both techniques yield high diagnostic accuracy for carcinomas, from 89% in FNAB to 98% in CB (1). Coaxial biopsy technique has a reported overall diagnostic accuracy for both malignant and benign lesions ranging from 82.6% to 95% (2–4).Besides the needle type, other factors such as lesion size, nature of the lesion, experience and skills of interventional radiologist influence the diagnostic accuracy. Lesion size ≥1 cm is reported as a significant risk factor decreasing diagnostic accuracy, but in published data lesions >5 cm and even ≥3.1 cm, are also identified as factors that decrease the diagnostic accuracy mainly due to the higher rates of necrosis (4, 5).The most frequent complication in lung biopsy is pneumothorax, with the reported pooled rate 25.3% for CB and 18.8% for FNAB (6).The aim of this retrospective single-center study was to determine diagnostic accuracy and complication rates of percutaneous CT-guided coaxial lung biopsies of pulmonary lesions stratified by lesion size into <35 mm, 30–50 mm, and >50 mm lesions, as well as to identify the relevant risk factors.     

``Oblique Path'— The Optimal Needle Path for Computed Tomography-Guided Biopsy of Small Subpleural Lesions

Purpose: To determine the optimal needle path for computed tomography (CT)-guided biopsy of small lesions just beneath the pleura. Methods: A biopsy of 61 subpleural lesions measuring less than 2.5 cm was done prospectively with regard to the approach and the results. One of two needle paths was randomly chosen: a nearly right angle path (n= 30) or an ``oblique path' in which the needle was sharply inclined within the slice, using a course nearly parallel to the pleura (n= 32). One lesion was sampled twice. The procedures were considered successful when diagnostic samples were obtained. Results: The success rate of the oblique path was 81.2% and that of the near 90° path was 43.3% (p < 0.05). Conclusion: For percutaneous biopsy of small subpleural lesions under CT guidance, the oblique path is better than the perpendicular path. Received: 0/00/00/Accepted: 0/00/00     

CT导引下经皮肺组织活检术常见并发症及穿刺体会

目的分析CT导引下经皮肺组织活检术常见并发症,探讨穿刺操作技巧在减少手术并发症中的作用。方法收集2006年6月-2007年6月肺内实质性占位病灶行经皮肺肿块穿刺活检术116例,分析并发症的种类、主要并发症及其处理措施,探讨CT导引下经皮肺内肿物穿刺过程及其体会。结果116例经皮肺肿块穿刺活检术均穿刺成功。发生的并发症主要有气胸(15.5%)、穿刺道出血(10.3%),咯血(4.3%),其他(1.7%)。除1例气胸患者予以胸腔闭式引流外,余均未作特殊处理。结论CT导引下经皮肺穿刺术是一项安全有效的诊断技术。穿刺术前病灶评估、术中精确定位及正确训练患者呼吸运动以配合穿刺操作可减少并发症。