Pneumothorax after computed tomography-guided lung biopsy: Utility of immediate post-procedure computed tomography and one-hour delayed chest radiography

Purpose To evaluate the utility of immediate post-procedure computed tomography (IPP-CT) and routine one-hour chest radiography (1HR-CXR) for detecting and managing pneumothorax in patients undergoing computed tomography (CT)-guided percutaneous lung biopsy. Materials and methods All CT-guided percutaneous lung biopsies performed between May 2014 and August 2021 at a single institution were included. Data from 275 procedures performed on 267 patients (147 men; mean age: 63.5 ± 14.1 years; range 18–91 years) who underwent routine 1HR-CXR were reviewed. Incidences of pneumothorax and procedure-related complications on IPP-CT and 1HR-CXR were recorded. Associated variables, including tract embolization methods, needle diameter/type, access site, lesion size, needle tract distance, and number of biopsy samples obtained were analyzed and compared between groups with and without pneumothorax. Results Post-procedure complications included pneumothorax (30.9%, 85/275) and hemoptysis (0.7%, 2/275). Pneumothorax was detected on IPP-CT and 1HR-CXR in 89.4% (76/85) and 100% (85/85), respectively. A chest tube was placed in 4% (11/275) of the cases. In 3.3% (9/275) of the cases, delayed pneumothorax was detected only on 1HR-CXR, but no patient in this group necessitated chest tube placement. The incidence of pneumothorax was not significantly different between tract embolization methods (p = 0.36), needle diameters (p = 0.36) and types (p = 0.33), access sites (p = 0.07), and lesion sizes (p = 0.88). On logistic regression, a lower biopsy sample number (OR = 0.49) was a protective factor, but a longer needle tract distance (OR = 1.16) was a significant risk factor for pneumothorax. Conclusion Following CT-guided percutaneous lung biopsy, pneumothorax detected on IPP-CT strongly indicates persistent pneumothorax on 1HR-CXR and possible chest tube placement. If no pneumothorax is identified on IPP-CT, follow-up 1HR-CXR may be required only for those who develop symptoms of pneumothorax.

[1]  E. Paul,et al.  Gelfoam slurry tract occlusion after computed tomography‐guided percutaneous lung biopsy: Does it prevent major pneumothorax? , 2021, Journal of medical imaging and radiation oncology.

[2]  İsmail Devecioğlu,et al.  A Retrospective Analysis of the Effectiveness of Extrapleural Autologous Blood Patch Injection on Pneumothorax and Intervention Need in CT-guided Lung Biopsy , 2021, CardioVascular and Interventional Radiology.

[3]  B. Siewert,et al.  Safely Shortening the Observation Time After CT-Guided Lung Procedures. , 2021, Journal of the American College of Radiology : JACR.

[4]  M. Cabana,et al.  Screening for Lung Cancer: US Preventive Services Task Force Recommendation Statement. , 2021, JAMA.

[5]  Sanjay Gupta,et al.  Society of Interventional Radiology Quality Improvement Standards on Percutaneous Needle Biopsy in Adult and Pediatric Patients. , 2020, Journal of vascular and interventional radiology : JVIR.

[6]  K. Jeon,et al.  Pneumothorax after CT-guided transthoracic lung biopsy: A comparison between immediate and delayed occurrence , 2020, PloS one.

[7]  S. Shenhar-Tsarfaty,et al.  The yield of immediate post lung biopsy CT in predicting iatrogenic pneumothorax , 2020, BMC Pulmonary Medicine.

[8]  E. Ziv,et al.  Autologous Blood Patch Injection versus Hydrogel Plug in CT-guided Lung Biopsy: A Prospective Randomized Trial. , 2019, Radiology.

[9]  E. J. Hwang,et al.  Time-dependent analysis of incidence, risk factors and clinical significance of pneumothorax after percutaneous lung biopsy , 2018, European Radiology.

[10]  A. Rattan,et al.  Delayed Tension Pneumothorax - Identification and Treatment in Traumatic Bronchial Injury: An Interesting Presentation. , 2017, Journal of clinical and diagnostic research : JCDR.

[11]  J. Golzarian,et al.  Is a Routine Chest X-ray Necessary in Every Patient After Percutaneous CT-Guided Lung Biopsy? A Retrospective Review of 278 Cases , 2017, CardioVascular and Interventional Radiology.

[12]  M. Oudkerk,et al.  Complication rates of CT-guided transthoracic lung biopsy: meta-analysis , 2016, European Radiology.

[13]  R Core Team,et al.  R: A language and environment for statistical computing. , 2014 .

[14]  D. Madoff,et al.  Percutaneous Lung Biopsy: Technique, Efficacy, and Complications , 2013, Seminars in Interventional Radiology.

[15]  R. Bertino,et al.  Effect of intraparenchymal blood patch on rates of pneumothorax and pneumothorax requiring chest tube placement after percutaneous lung biopsy. , 2013, AJR. American journal of roentgenology.

[16]  M. Maher,et al.  CT-guided percutaneous needle biopsy of the chest: preprocedural evaluation and technique. , 2011, AJR. American journal of roentgenology.

[17]  Katherine R Birchard,et al.  Transthoracic needle biopsy. , 2011, Seminars in interventional radiology.

[18]  Donald L. Miller,et al.  Quality improvement guidelines for percutaneous needle biopsy. , 2010, Journal of vascular and interventional radiology : JVIR.

[19]  S. Han,et al.  Incidence and risk factors of delayed pneumothorax after transthoracic needle biopsy of the lung. , 2004, Chest.

[20]  R. Light,et al.  Significance of iatrogenic pneumothoraces. , 1994, Chest.