Impact of quantitative pulmonary emphysema score on the rate of pneumothorax and chest tube insertion in CT-guided lung biopsies.
Journal
Scientific reports
ISSN: 2045-2322
Titre abrégé: Sci Rep
Pays: England
ID NLM: 101563288
Informations de publication
Date de publication:
03 07 2020
03 07 2020
Historique:
received:
06
03
2020
accepted:
28
05
2020
entrez:
5
7
2020
pubmed:
6
7
2020
medline:
15
12
2020
Statut:
epublish
Résumé
The aim of this study was to evaluate the risk of pneumothorax and need for chest tube insertion in CT-guided lung biopsies and identify predictors focusing on pulmonary emphysema determined with quantitative computed tomography. To that end, we retrospectively analysed the incidence of pneumothorax and chest tube insertion in 371 CT-guided lung biopsies with respect to the quantitative emphysema score determined with the density mask technique. Other possible impact factors considered were lesion diameter, length of biopsy pathway within the lung parenchyma, lung lobe, needle size, puncture technique, patient positioning and interventionalist's level of experience. Quantitative emphysema scores of the lung were significantly higher in patients who developed instant pneumothorax (27%, p < 0.0001), overall pneumothorax (38%, p = 0.001) and had chest tube insertion (9%, p = 0.006) compared to those who did not when analysed with the Mann-Whitney U-test. In logistic regression analysis with inclusion of the other possible impact factors, the quantitative emphysema score remained a statistically significant predictor for all three output parameters. This was confirmed with least absolute shrinkage and selection operator (Lasso) regression analysis. In conclusion, quantitatively determined pulmonary emphysema is a positive predictor of the pneumothorax rate in CT-guided lung biopsy and likelihood of chest tube insertion.
Identifiants
pubmed: 32620852
doi: 10.1038/s41598-020-67348-0
pii: 10.1038/s41598-020-67348-0
pmc: PMC7335035
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
10978Références
MacMahon, H. et al. Guidelines for management of incidental pulmonary nodules detected on CT images: from the Fleischner society 2017. Radiology 284, 228–243. https://doi.org/10.1148/radiol.2017161659 (2017).
doi: 10.1148/radiol.2017161659
pubmed: 28240562
Dale, C. R., Madtes, D. K., Fan, V. S., Gorden, J. A. & Veenstra, D. L. Navigational bronchoscopy with biopsy versus computed tomography-guided biopsy for the diagnosis of a solitary pulmonary nodule: a cost-consequences analysis. J. Bronchol, Interv. Pulmonol. 19, 294–303. https://doi.org/10.1097/LBR.0b013e318272157d (2012).
doi: 10.1097/LBR.0b013e318272157d
Bhatt, K. M. et al. Electromagnetic navigational bronchoscopy versus CT-guided percutaneous sampling of peripheral indeterminate pulmonary nodules: a cohort study. Radiology 286, 1052–1061. https://doi.org/10.1148/radiol.2017170893 (2018).
doi: 10.1148/radiol.2017170893
pubmed: 29156147
Tomiyama, N. et al. CT-guided needle biopsy of lung lesions: a survey of severe complication based on 9783 biopsies in Japan. Eur J Radiol 59, 60–64. https://doi.org/10.1016/j.ejrad.2006.02.001 (2006).
doi: 10.1016/j.ejrad.2006.02.001
pubmed: 16530369
Bandyopadhyay, S. et al. Segmental approach to lung volume reduction therapy for emphysema patients. Respir. Int. Rev. Thorac. Dis. 89, 76–81. https://doi.org/10.1159/000369036 (2015).
doi: 10.1159/000369036
Boskovic, T. et al. Pneumothorax after transthoracic needle biopsy of lung lesions under CT guidance. J. Thorac. Dis. 6(Suppl 1), S99–S107. https://doi.org/10.3978/j.issn.2072-1439.2013.12.08 (2014).
doi: 10.3978/j.issn.2072-1439.2013.12.08
pubmed: 24672704
pmcid: 3966161
Ozturk, K., Soylu, E., Gokalp, G. & Topal, U. Risk factors of pneumothorax and chest tube placement after computed tomography-guided core needle biopsy of lung lesions: a single-centre experience with 822 biopsies. Pol. J. Radiol. 83, e407–e414. https://doi.org/10.5114/pjr.2018.79205 (2018).
doi: 10.5114/pjr.2018.79205
pubmed: 30655918
pmcid: 6334126
Laurent, F., Michel, P., Latrabe, V., Tunon de Lara, M. & Marthan, R. Pneumothoraces and chest tube placement after CT-guided transthoracic lung biopsy using a coaxial technique: incidence and risk factors. AJR Am. J. Roentgenol. 172, 1049–1053. https://doi.org/10.2214/ajr.172.4.10587145 (1999).
doi: 10.2214/ajr.172.4.10587145
pubmed: 10587145
Topal, U. & Ediz, B. Transthoracic needle biopsy: factors effecting risk of pneumothorax. Eur. J. Radiol. 48, 263–267. https://doi.org/10.1016/s0720-048x(03)00058-5 (2003).
doi: 10.1016/s0720-048x(03)00058-5
pubmed: 14652144
Cox, J. E., Chiles, C., McManus, C. M., Aquino, S. L. & Choplin, R. H. Transthoracic needle aspiration biopsy: variables that affect risk of pneumothorax. Radiology 212, 165–168. https://doi.org/10.1148/radiology.212.1.r99jl33165 (1999).
doi: 10.1148/radiology.212.1.r99jl33165
pubmed: 10405737
Saji, H. 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 121, 1521–1526. https://doi.org/10.1378/chest.121.5.1521 (2002).
doi: 10.1378/chest.121.5.1521
pubmed: 12006438
Hiraki, T. 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. 194, 809–814. https://doi.org/10.2214/AJR.09.3224 (2010).
doi: 10.2214/AJR.09.3224
pubmed: 20173164
Gevenois, P. A., de Maertelaer, V., De Vuyst, P., Zanen, J. & Yernault, J. C. Comparison of computed density and macroscopic morphometry in pulmonary emphysema. Am. J. Respir. Crit. Care Med. 152, 653–657. https://doi.org/10.1164/ajrccm.152.2.7633722 (1995).
doi: 10.1164/ajrccm.152.2.7633722
pubmed: 7633722
Chami, H. A. et al. Predictors of pneumothorax after CT-guided transthoracic needle lung biopsy: the role of quantitative CT. Clin. Radiol. 70, 1382–1387. https://doi.org/10.1016/j.crad.2015.08.003 (2015).
doi: 10.1016/j.crad.2015.08.003
pubmed: 26392317
Lendeckel, D. et al. Pulmonary emphysema is a predictor of pneumothorax after CT-guided transthoracic pulmonary biopsies of pulmonary nodules. PLoS ONE 12, e0178078. https://doi.org/10.1371/journal.pone.0178078 (2017).
doi: 10.1371/journal.pone.0178078
pubmed: 28574995
pmcid: 5456052
Lee, D. S., Bak, S. H., Jeon, Y. H., Kwon, S. O. & Kim, W. J. Perilesional emphysema as a predictor of risk of complications from computed tomography-guided transthoracic lung biopsy. Jpn. J. Radiol. 37, 808–816. https://doi.org/10.1007/s11604-019-00880-w (2019).
doi: 10.1007/s11604-019-00880-w
pubmed: 31541398
Yeow, K. M. et al. Risk factors of pneumothorax and bleeding: multivariate analysis of 660 CT-guided coaxial cutting needle lung biopsies. Chest 126, 748–754. https://doi.org/10.1378/chest.126.3.748 (2004).
doi: 10.1378/chest.126.3.748
pubmed: 15364752
Zhang, L. et al. Coaxial technique-promoted diagnostic accuracy of CT-guided percutaneous cutting needle biopsy for small and deep lung lesions. PLoS ONE 13, e0192920. https://doi.org/10.1371/journal.pone.0192920 (2018).
doi: 10.1371/journal.pone.0192920
pubmed: 29447239
pmcid: 5814003
Paulson, E. K., Sheafor, D. H., Enterline, D. S., McAdams, H. P. & Yoshizumi, T. T. CT fluoroscopy-guided interventional procedures: techniques and radiation dose to radiologists. Radiology 220, 161–167. https://doi.org/10.1148/radiology.220.1.r01jl29161 (2001).
doi: 10.1148/radiology.220.1.r01jl29161
pubmed: 11425990
Winokur, R. S., Pua, B. B., Sullivan, B. W. & Madoff, D. C. Percutaneous lung biopsy: technique, efficacy, and complications. Semin. Interv. Radiol. 30, 121–127. https://doi.org/10.1055/s-0033-1342952 (2013).
doi: 10.1055/s-0033-1342952
Shiekh, Y. et al. Evaluation of various patient-, lesion-, and procedure-related factors on the occurrence of pneumothorax as a complication of CT-guided percutaneous transthoracic needle biopsy. Pol. J. Radiol. 84, e73–e79. https://doi.org/10.5114/pjr.2019.82837 (2019).
doi: 10.5114/pjr.2019.82837
pubmed: 31019598
pmcid: 6479149
Wang, Z. et al. Optimal threshold in CT quantification of emphysema. Eur. Radiol. 23, 975–984. https://doi.org/10.1007/s00330-012-2683-z (2013).
doi: 10.1007/s00330-012-2683-z
pubmed: 23111815
Lynch, D. A. & Al-Qaisi, M. A. Quantitative computed tomography in chronic obstructive pulmonary disease. J. Thorac. Imaging 28, 284–290. https://doi.org/10.1097/RTI.0b013e318298733c (2013).
doi: 10.1097/RTI.0b013e318298733c
pubmed: 23748651
pmcid: 4161463
Yeow, K. M. et al. Risk factors for pneumothorax and bleeding after CT-guided percutaneous coaxial cutting needle biopsy of lung lesions. J. Vasc. Interv. Radiol. 12, 1305–1312. https://doi.org/10.1016/s1051-0443(07)61556-5 (2001).
doi: 10.1016/s1051-0443(07)61556-5
pubmed: 11698630
Lynch, D. A. et al. CT-based visual classification of emphysema: association with mortality in the COPDGene study. Radiology 288, 859–866. https://doi.org/10.1148/radiol.2018172294 (2018).
doi: 10.1148/radiol.2018172294
pubmed: 29762095
pmcid: 6122195
Hiraki, T. et al. CT fluoroscopy-guided biopsy of 1,000 pulmonary lesions performed with 20-gauge coaxial cutting needles: diagnostic yield and risk factors for diagnostic failure. Chest 136, 1612–1617. https://doi.org/10.1378/chest.09-0370 (2009).
doi: 10.1378/chest.09-0370
pubmed: 19429718
Beck, K. S. et al. CT-guided coaxial biopsy of malignant lung lesions: are cores from 20-gauge needle adequate for histologic diagnosis and molecular analysis?. J. Thorac. Dis. 11, 753–765. https://doi.org/10.21037/jtd.2019.02.48 (2019).
doi: 10.21037/jtd.2019.02.48
pubmed: 31019763
pmcid: 6462692
Lim, C., Lee, K. Y., Kim, Y. K., Ko, J. M. & Han, D. H. CT-guided core biopsy of malignant lung lesions: how many needle passes are needed?. J. Med. Imaging Radiat. Oncol. 57, 652–656. https://doi.org/10.1111/1754-9485.12054 (2013).
doi: 10.1111/1754-9485.12054
pubmed: 24283552
Elshafee, A. S. et al. Complications of CT-guided lung biopsy with a non-coaxial semi-automated 18 gauge biopsy system: frequency, severity and risk factors. PLoS ONE 14, e0213990. https://doi.org/10.1371/journal.pone.0213990 (2019).
doi: 10.1371/journal.pone.0213990
pubmed: 30883575
pmcid: 6422294
Collings, C. L., Westcott, J. L., Banson, N. L. & Lange, R. C. Pneumothorax and dependent versus nondependent patient position after needle biopsy of the lung. Radiology 210, 59–64. https://doi.org/10.1148/radiology.210.1.r99ja1759 (1999).
doi: 10.1148/radiology.210.1.r99ja1759
pubmed: 9885587
Masterson, A. V., Haslam, P., Logan, P. M. & Lee, M. J. Patient positioning after lung biopsy: influence on the incidence of pneumothorax. Can. Assoc. Radiol. J. 54, 31–34 (2003).
pubmed: 12625081
Drumm, O. et al. CT-guided lung biopsy: effect of biopsy-side down position on pneumothorax and chest tube placement. Radiology 292, 190–196. https://doi.org/10.1148/radiol.2019182321 (2019).
doi: 10.1148/radiol.2019182321
pubmed: 31084480
Leger, T. et al. Does ipsilateral-dependent positioning during percutaneous lung biopsy decrease the risk of pneumothorax?. AJR Am. J. Roentgenol. 212, 461–466. https://doi.org/10.2214/AJR.18.19871 (2019).
doi: 10.2214/AJR.18.19871
pubmed: 30540211