open access

Vol 88, No 2 (2020)
ORIGINAL PAPERS
Published online: 2020-04-30
Submitted: 2019-11-05
Accepted: 2020-02-13
Get Citation

Lung density in the trajectory path is a strong indicator of patients sustaining a pneumothorax during CT-guided lung biopsy

Charbel Saade, Salah Zien-El-Dine, Nadine Hamieh, Batoul Dekmak, Diamond Ghieh, Youssef Ghosn, Gilbert Maroun, Fadi El-Merhi
DOI: 10.5603/ARM.2020.0084
·
Pubmed: 32383461
·
Adv Respir Med 2020;88(2):108-115.

open access

Vol 88, No 2 (2020)
ORIGINAL PAPERS
Published online: 2020-04-30
Submitted: 2019-11-05
Accepted: 2020-02-13

Abstract

Introduction: The purpose is to evaluate the prognostic significance of lung parenchymal density during percutaneous coaxial cutting needle lung biopsy (PNLB). Materials and methods: Retrospective analysis of 179 consecutive patients (106 males, 73 females; mean age 59.16 ± 16.34 years) undergoing PNLB was included. Mean lobar parenchymal lung density, mean densities anterior to the lesion and posterior to the chest wall in the needle trajectory path were measured in HU. Lesion location and needle trajectory were also measured. Fisher’s exact test and Chi-square test were conducted to analyze the categorical variables. ANOVA test was done to examine continuous and normally distributed variables. Statistical significance was considered when p < 0.05. Results: Mean lobar parenchymal lung density (p < 0.05) and mean parenchymal lung density relative to the needle trajectory path were below -800 HU in patients who sustained a pneumothorax. Increase in the number of pleural passes was significantly associated with the risk of patients having pneumothorax (p < 0.05). The mean distance from the skin to the lesion and needle trajectory angle were not statistically different among patients with and without pneumothorax (p > 0.05). Conclusion: Lobar parenchymal density and lung parenchymal density anterior to the lesion and posterior to the chest wall in the needle trajectory path could be used as predicting parameters in patients undergoing PNLB who sustained a pneumothorax. These findings can help interventional radiologist further assess risk of pneumothorax when preforming such procedure.

Abstract

Introduction: The purpose is to evaluate the prognostic significance of lung parenchymal density during percutaneous coaxial cutting needle lung biopsy (PNLB). Materials and methods: Retrospective analysis of 179 consecutive patients (106 males, 73 females; mean age 59.16 ± 16.34 years) undergoing PNLB was included. Mean lobar parenchymal lung density, mean densities anterior to the lesion and posterior to the chest wall in the needle trajectory path were measured in HU. Lesion location and needle trajectory were also measured. Fisher’s exact test and Chi-square test were conducted to analyze the categorical variables. ANOVA test was done to examine continuous and normally distributed variables. Statistical significance was considered when p < 0.05. Results: Mean lobar parenchymal lung density (p < 0.05) and mean parenchymal lung density relative to the needle trajectory path were below -800 HU in patients who sustained a pneumothorax. Increase in the number of pleural passes was significantly associated with the risk of patients having pneumothorax (p < 0.05). The mean distance from the skin to the lesion and needle trajectory angle were not statistically different among patients with and without pneumothorax (p > 0.05). Conclusion: Lobar parenchymal density and lung parenchymal density anterior to the lesion and posterior to the chest wall in the needle trajectory path could be used as predicting parameters in patients undergoing PNLB who sustained a pneumothorax. These findings can help interventional radiologist further assess risk of pneumothorax when preforming such procedure.

Get Citation

Keywords

lung biopsy; iatrogenic pneumothorax; lung parenchymal density; parenchymal mass; needle trajectory

About this article
Title

Lung density in the trajectory path is a strong indicator of patients sustaining a pneumothorax during CT-guided lung biopsy

Journal

Advances in Respiratory Medicine

Issue

Vol 88, No 2 (2020)

Pages

108-115

Published online

2020-04-30

DOI

10.5603/ARM.2020.0084

Pubmed

32383461

Bibliographic record

Adv Respir Med 2020;88(2):108-115.

Keywords

lung biopsy
iatrogenic pneumothorax
lung parenchymal density
parenchymal mass
needle trajectory

Authors

Charbel Saade
Salah Zien-El-Dine
Nadine Hamieh
Batoul Dekmak
Diamond Ghieh
Youssef Ghosn
Gilbert Maroun
Fadi El-Merhi

References (17)
  1. Gupta S, Wallace MJ, Cardella JF, et al. Quality improvement guidelines for percutaneous needle biopsy. J Vasc Interv Radiol. 2010; 21(7): 969–975.
  2. Wu CC, Maher MM, Shepard JAO. Complications of CT-guided percutaneous needle biopsy of the chest: prevention and management. AJR Am J Roentgenol. 2011; 196(6): W678–W682.
  3. Covey AM, Gandhi R, Brody LA, et al. Factors associated with pneumothorax and pneumothorax requiring treatment after percutaneous lung biopsy in 443 consecutive patients. J Vasc Interv Radiol. 2004; 15(5): 479–483.
  4. Hiraki T. Takao Hiraki's work on interventional radiology. World J Radiol. 2010; 2(12): 474–478.
  5. Hiraki T, Mimura H, Gobara H, et al. Incidence of and risk factors for pneumothorax and chest tube placement after CT fluoroscopy-guided percutaneous lung biopsy: retrospective analysis of the procedures conducted over a 9-year period. AJR Am J Roentgenol. 2010; 194(3): 809–814.
  6. Saji H, Nakamura H, Tsuchida T, et al. The incidence and the risk of pneumothorax and chest tube placement after percutaneous CT-guided lung biopsy: the angle of the needle trajectory is a novel predictor. Chest. 2002; 121(5): 1521–1526.
  7. Asai N, Ohkuni Y, Yamazaki I, et al. Therapeutic impact of CT-guided percutaneous catheter drainage in treatment of deep tissue abscesses. Braz J Infect Dis. 2013; 17(4): 483–486.
  8. Ohno Y, Hatabu H, Takenaka D, et al. CT-guided transthoracic needle aspiration biopsy of small (< or = 20 mm) solitary pulmonary nodules. AJR Am J Roentgenol. 2003; 180(6): 1665–1669.
  9. 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–S9S107.
  10. Patel IJ, Rahim S, Davidson JC, et al. Consensus guidelines for periprocedural management of coagulation status and hemostasis risk in percutaneous image-guided interventions. J Vasc Interv Radiol. 2012; 23(6): 727–736.
  11. Asai N, Kawamura Y, Yamazaki I, et al. Is emphysema a risk factor for pneumothorax in CT-guided lung biopsy? Springerplus. 2013; 2(1): 196.
  12. Chakrabarti B, Earis JE, Pandey R, et al. Risk assessment of pneumothorax and pulmonary haemorrhage complicating percutaneous co-axial cutting needle lung biopsy. Respir Med. 2009; 103(3): 449–455.
  13. Kakizawa H, Toyota N, Hieda M, et al. Risk factors for severity of pneumothorax after CT-guided percutaneous lung biopsy using the single-needle method. Hiroshima J Med Sci. 2010; 59(3): 43–50.
  14. O'Neill AC, McCarthy C, Ridge CA, et al. Rapid needle-out patient-rollover time after percutaneous CT-guided transthoracic biopsy of lung nodules: effect on pneumothorax rate. Radiology. 2012; 262(1): 314–319.
  15. 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): 748–754.
  16. Winokur RS, Pua BB, Sullivan BW, et al. Percutaneous lung biopsy: technique, efficacy, and complications. Semin Intervent Radiol. 2013; 30(2): 121–127.
  17. Kuriyama T, Masago K, Okada Y, et al. Computed tomography-guided lung biopsy: Association between biopsy needle angle and pneumothorax development. Mol Clin Oncol. 2018; 8(2): 336–341.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

Czasopismo Pneumonologia i Alergologia Polska dostęne jest również w Ikamed - księgarnia medyczna

Wydawcą serwisu jest "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail: viamedica@viamedica.pl