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Predictors of pneumothorax and chest drainage after percutaneous CT-guided lung biopsy: A prospective study

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Abstract

Objectives

We present an analysis of predictors of pneumothorax, and pneumothorax requiring chest drainage after CT-guided lung biopsy, in one of the largest Scandinavian dataset presented.

Methods

We prospectively registered 875 biopsy procedures from 786 patients in one institution from January 27, 2012, to March 1, 2017, and recorded complications including pneumothorax with or without chest drainage, and multiple variables we assumed could be associated with complications. We performed multivariable logistic regression analysis to identify predictors of pneumothorax and pneumothorax requiring chest drainage.

Results

Of the biopsied lesions, 65% were malignant, 29% benign, and 6% inconclusive. Pneumothorax occurred in 39% of the procedures and chest drainage was performed in 10%. In multivariable analysis, significant predictors of pneumothorax were emphysema (OR 1.92), smaller lesion size (OR 0.83, per 1 cm increase in lesion size), lateral body position during procedure (OR 2.00), longer needle time (OR 1.09, per minute), repositioning of coaxial needle with new insertion through pleura (OR 3.04), insertion through interlobar fissure (OR 5.21), and shorter distance to pleura (OR 0.79, per 1 cm increase in distance). Predictors of chest drainage were emphysema (OR 4.01), lateral body position (OR 2.61), and needle insertion through interlobar fissure (OR 4.17).

Conclusion

Predictors of pneumothorax were emphysema, lateral body position, needle insertion through interlobar fissure, repositioning of coaxial needle with new insertion through pleura, and shorter distance to pleura. The finding of lateral body position as a predictor of pneumothorax is not earlier described. Emphysema, lateral body position, and needle insertion through interlobar fissure were also predictors of chest drainage.

Key Points

• Pneumothorax is a frequent complication to CT-guided lung biopsy; a smaller fraction of these complications needs chest drainage.

• Predictors for pneumothorax are emphysema, smaller lesion size, lateral body position, longer needle time, repositioning of coaxial needle with new insertion through pleura, needle insertion through the interlobar fissure, and shorter distance to pleura.

• Predictors for requirement for chest drainage post CT-guided lung biopsy are emphysema, lateral body position, and needle insertion through the interlobar fissure.

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Abbreviations

CI:

Confidence interval

COPD:

Chronic obstructive pulmonary disease

CT:

Computer tomography

G:

Gauge, caliber of needle

OR:

Odds ratio

SD:

Standard deviation

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The authors state that this work has not received any funding.

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Correspondence to Espen Asak Ruud.

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Guarantor

The scientific guarantor of this publication is:

Haseem Ashraf, Associate professor, PhD. Faculty of Medicine, University of Oslo, Norway. Department of Thoracic Radiology. Akershus University Hospital, Norway

Homepage: https://www.med.uio.no/klinmed/english/people/aca/haseema/

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

Institutional statistical services at Akershus University Hospital.

Prof. Ashraf and prof. Stavem both have significant statistical expertise.

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Written informed consent was waived by the Institutional Review Board.

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Institutional Review Board approval was obtained.

Methodology

• prospective

• diagnostic or prognostic study

• performed at one institution

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Ruud, E.A., Stavem, K., Geitung, J.T. et al. Predictors of pneumothorax and chest drainage after percutaneous CT-guided lung biopsy: A prospective study. Eur Radiol 31, 4243–4252 (2021). https://doi.org/10.1007/s00330-020-07449-6

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  • DOI: https://doi.org/10.1007/s00330-020-07449-6

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