Dependent lesion positioning at CT-guided lung biopsy to reduce risk of pneumothorax
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INTERVENTIONAL
Dependent lesion positioning at CT-guided lung biopsy to reduce risk of pneumothorax Elisabeth Appel 1,2 & Sujithraj Dommaraju 1 & Andrés Camacho 1 & Masoud Nakhaei 1 & Bettina Siewert 1 & Muneeb Ahmed 1 & Alexander Brook 1 & Olga R. Brook 1 Received: 18 March 2020 / Revised: 20 April 2020 / Accepted: 9 June 2020 # European Society of Radiology 2020
Abstract Objectives To evaluate the impact of patient positioning during CT-guided lung biopsy on patients’ outcomes. Methods In this retrospective, IRB-approved, HIPAA-compliant study, consecutive CT-guided lung biopsies performed on 5/1/ 2015–12/26/2017 were included. Correlation between incidence of pneumothorax, chest tube placement, pulmonary bleeding with patient, and procedure characteristics was evaluated. Lesion-trachea-table angle (LTTA) was defined as an angle between the lesion, trachea, and horizontal line parallel to the table. Lesion above trachea has a positive LTTA. Univariate and multivariate logistic regression analysis was performed. Results A total of 423 biopsies in 409 patients (68 ± 11 years, 231/409, 56% female) were included in the study. Pneumothorax occurred in 83/423 (20%) biopsies with chest tube placed in 11/423 (3%) biopsies. Perilesional bleeding occurred in 194/423 (46%) biopsies and hemoptysis in 20/423 (5%) biopsies. Univariate analysis showed an association of pneumothorax with smaller lesions (p = 0.05), positive LTTA (p = 0.002), and lesions not attached to pleura (p = 0.026) with multivariate analysis showing lesion size and LTTA to be independent risk factors. Univariate analysis showed an association of increased pulmonary bleeding with smaller lesions (p < 0.001), no attachment to the pleura (p < 0.001), needle throw < 16 mm (p = 0.05), and a longer needle path (p < 0.001). Multivariate analysis showed lesion size, a longer needle path, and lesions not attached to the pleura to be independently associated with perilesional bleeding. Risk factors for hemoptysis were longer needle path (p = 0.002), no attachment to the pleura (p = 0.03), and female sex (p = 0.04). Conclusions Interventional radiologists can reduce the pneumothorax risk during the CT-guided biopsy by positioning the biopsy site below the trachea. Key Points • Positioning patient with lesion to be below the trachea for the CT-guided lung biopsy results in lower rate of pneumothorax, as compared with the lesion above the trachea. • Positioning patient with lesion to be below the trachea for the CT-guided lung biopsy does not affect rate of procedureassociated pulmonary hemorrhage or hemoptysis. Keywords Pneumothorax . Lung . Biopsy . Patient positioning . Tomography, X-ray computed
* Olga R. Brook [email protected] 1
Department of Radiology, Beth Israel Deaconess Medical Center, 1 Deaconess Rd, Boston, MA 02215, USA
2
Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
Abbreviations COPD Chronic obstructive pulmonary disease ER Emergency room FNA Fine-ne
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