ISSN: 1899-0967
Polish Journal of Radiology
Established by prof. Zygmunt Grudziński in 1926 Sun
Current issue Archive About the journal Editorial board Abstracting and indexing Contact Instructions for authors
SCImago Journal & Country Rank

vol. 84
Original paper

Evaluation of various patient-, lesion-, and procedure-related factors on the occurrence of pneumothorax as a complication of CT-guided percutaneous transthoracic needle biopsy

Yassar Shiekh, Wani A. Haseeb, Imza Feroz, Feroze A. Shaheen, Tariq A. Gojwari, Naseer A. Choh

© Pol J Radiol 2019; 84: e73-e79
Online publish date: 2019/01/28
View full text
Get citation
JabRef, Mendeley
Papers, Reference Manager, RefWorks, Zotero
To assess the influence of various patient-, lesion-, and procedure-related variables on the occurrence of pneumothorax as a complication of CT-guided percutaneous transthoracic needle biopsy.

Material and methods
In a total of 208 patients, 215 lung/mediastinal lesions (seven patients were biopsied twice) were sampled under CT guidance using coaxial biopsy set via percutaneous transthoracic approach. Incidence of post procedure pneumothorax was seen and the influence of various patient-, lesion-, and procedure-related variables on the frequency of pneumothorax with special emphasis on procedural factors like dwell time and needle-pleural angle was analysed.

Pneumothorax occurred in 25.12% (54/215) of patients. Increased incidence of pneumothorax had a statistically significant correlation with age of the patient (p = 0.0020), size (p = 0.0044) and depth (p = 0.0001) of the lesion, and needle-pleural angle (p = 0.0200). Gender of the patient (p = 0.7761), emphysema (p = 0.2724), site of the lesion (p = 0.9320), needle gauge (p = 0.7250), patient position (p = 0.9839), and dwell time (p = 0.9330) had no significant impact on the pneumothorax rate.

This study demonstrated a significant effect of the age of the patient, size and depth of the lesion, and needle-pleural angle on the incidence of post-procedural pneumothorax. Emphysema as such had no effect on pneumothorax rate, but once pneumothorax occurred, emphysematous patients were more likely to be symptomatic, necessitating chest tube placement. Gender of the patient, site of the lesion, patient position during the procedure, and dwell time had no statistically significant relation with the frequency of post-procedural pneumothorax. Surprisingly, needle gauge had no significant effect on pneumothorax frequency, but due to the small sample size, non-randomisation, and bias in needle size selection as per lesion size, further studies are required to fully elucidate the causal relationship between needle size and post-procedural pneumothorax rate. The needle should be as perpendicular as possible to the pleura (needle-pleural angle close to 90°), to minimise the possibility of pneumothorax after percutaneous transthoracic needle biopsy.


post-procedural pneumothorax, percutaneous transthoracic needle biopsy, dwell time, needle gauge, needlepleural angle

Larscheid RC, Thorpe PE, Scott WJ. Percutaneous transthoracic needle aspiration biopsy: a comprehensive review of its current role in the diagnosis and treatment of lung tumors. Chest 1998; 114: 704-709.
Leyden OO. Uberinfektiose pneumonic. Dtsch Med Wochenschr 1883; 9: 52-54.
Jereb M, Us Krasovec M. Transthoracic needle biopsy of mediastinal and hilar lesions. Cancer 1977; 40: 1354-1357.
Jereb M. The usefulness of needle biopsy in chest lesions of different sizes and locations. Radiology 1980; 134: 13-15.
Hirose T, Mori K, Machida S, et al. Computed tomographic fluoroscopy-guided transthoracic needle biopsy for diagnosis of pulmonary nodules. Jpn J Clin Oncol 2000; 30: 259-262.
Westcott JL. Percutaneous transthoracic needle biopsy. Radiology 1988; 169: 593-601.
van Sonnenberg E, Lin AS, Deutsch AL, et al. Percutaneous biopsy of difficult mediastinal, hilar, and pulmonary lesions by computed tomographic guidance and a modified coaxial technique. Radiology 1983; 148: 300-302.
Stanley JH, Fish GD, Andriole JG, et al. Lung lesions: cytologic diagnosis by fine needle biopsy. Radiology 1987; 162: 389-391.
Khouri NF, Stitik FP, Erozan YS, et al. Transthoracic needle aspiration biopsy of benign and malignant lung lesions. AJR Am J Roentgenol 1985; 144: 281-288.
Li H, Boiselle PM, Shepard JO, et al. Diagnostic accuracy and safety of CT-guided percutaneous needle aspiration biopsy of the lung: comparison of small and large pulmonary nodules. AJR Am J Roentgenol 1996; 167: 105-109.
Tsukada H, Satou T, Iwashima A, et al. Diagnostic accuracy of CT-guided automated needle biopsy of lung nodules. AJR Am J Roentgenol 2000; 175: 239-243.
Perlmutt LM, Johnston WW, Dunnick NR. Percutaneous transthoracic needle aspiration: a review. AJR Am J Roentgenol 1989; 152: 451-455.
Kazerooni EA, Lim FT, Mikhail A, et al. Risk of pneumothorax in CT-guided transthoracic needle aspiration biopsy of the lung. Radiology 1996; 198: 371-375.
Cox JE, Chiles C, Aquino SL, et al. Transthoracic needle aspiration biopsy: variables that affect risk of pneumothorax. Radiology 1999; 212: 165-168.
Yamagami T, Nakamura T, Iida S, et al. Management of pneumothorax after per-cutaneous CT-guided lung biopsy. Chest 2002; 121: 1159-1164.
Laurent F, Michel P, Latrabe V, et al. Pneumothoraces and chest tube placement after CT-guided transthoracic lung biopsy using a coaxial technique. AJR Am J Roentgenol 1999; 172: 1049-1053.
Laurent F, Labtrabe V, Vergier B, et al. Percutaneous CT-guided biopsy of the lung: comparison between aspiration and automated cutting needles using a coaxial technique. Cardiovasc Intervent Radiol 2000; 23: 266-272.
Haramati LB, Austin JH. Complications after CT-guided biopsy through aerated versus non-aerated lung. Radiology 1991; 181: 778.
Khan MF, Straub R, Moghaddam SR, et al. Variables affecting the risk of pneumothorax and intrapulmonary hemorrhage in CT-guided transthoracic biopsy. Eur Radiol 2008; 18: 1356-1363.
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: 748-754.
Sinner WN. Complications of percutaneous transthoracic needle aspiration biopsy. Acta Radiol 1976; 17: 813-828.
Herman PG, Hessel SJ. The diagnostic accuracy and complications of closed lung biopsies. Radiology 1977; 125: 11-14.
Tolly TL, Feldmeier JE, Czcernecki D. Air embolism complicating percutaneous lung biopsy. AJR Am J Roentgenol 1988; 150: 555-556.
Aberle DR, Gamsu G, Golden JA. Fatal systemic arterial air embolism following lung needle aspiration. Radiology 1987; 165: 351-353.
Muller NL, Bergin CJ, Miller RR, et al. Seeding of malignant cells into the needle track after lung and pleural biopsy. Can Assoc Radiol J 1986; 37: 192-194.
Graham RJ, Heyd RL, Raval VA, et al. Lung torsion after percutaneous needle biopsy of lung. AJR Am J Roentgenol 1992; 159: 35-37.
Ko JP, Shepard JO, Drucker EA, et al. Factors influencing pneumothorax rate at lung biopsy: are dwell time and angle of pleural puncture contributing factors? Radiology 2001; 218: 491-496.
Charig MJ, Phillips AJ. CT-guided cutting needle biopsy of lung lesions-safety and efficacy of an out-patient service. Clin Radiol 2000; 55: 964-969.
Heyer CM, Reichelt S, Peters SA, et al. Computed tomography-navigated transthoracic core biopsy of pulmonary lesions: which factors affect diagnostic yield and complication rates? Acad Radiol 2008; 15: 1017-1026.
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: 449-455.
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: 809-814.
Moore EH. Technical aspects of needle aspiration lung biopsy: a personal perspective. Radiology 1998; 208: 303-318.
Moore EH, Shelton DK, Wisner ER, et al. Needle aspiration lung biopsy: re-evaluation of the blood patch technique in an equine model. Radiology 1995; 196: 183-186.
Quick links
© 2019 Termedia Sp. z o.o. All rights reserved.
Developed by Bentus.
PayU - płatności internetowe