CHEST RADIOLOGY / ORIGINAL PAPER
Relationship between different techniques and complications in CT-guided transthoracic lung biopsies: a single-centre comprehensive analysis CT-guided lung biopsy: techniques and associated complications
1
University of Health Sciences, Beyhekim Education and Research Hospital, Konya, Turkey
2
Necmettin Erbakan University, Faculty of Medicine, Turkey
Submission date: 2025-09-13
Acceptance date: 2025-10-01
Publication date: 2025-10-15
Corresponding author
Halil İbrahim Şara
University of Health Sciences, Beyhekim Education and Research Hospital, Beyhekim Mah. Devlethane Sok. No:2/C 42130 Selçuklu/Konya, Turkey
University of Health Sciences, Beyhekim Education and Research Hospital, Beyhekim Mah. Devlethane Sok. No:2/C 42130 Selçuklu/Konya, Turkey
Pol J Radiol, 2025; 90: 505-518
KEYWORDS
TOPICS
ABSTRACT
Purpose:
To evaluate the relationship between different techniques, lesion characteristics, and the development of pneumothorax (Ptx), chest tube-requiring Ptx, and type 1 parenchymal contusion (T1PC) in computed tomographyguided transthoracic lung biopsies (CTTB).
Material and methods:
This retrospective study included 510 patients who underwent CTTB between 2015 and 2020. Patients were classified according to needle system (coaxial (Cx)/non-coaxial (NCx)), needle gauge, use of autologous blood clot (OBC), lesion size, location, approach path, pleural puncture count, number of specimens, and presence of emphysema along the needle tract. Complications were assessed with post-procedural CT. Univariate and multivariate logistic regression analyses were performed.
Results:
Ptx was more frequent in males, in the presence of emphysema along the needle tract, with middle lobe lesions, lateral approach, ≥ 3 pleural passes, ≥ 3 samples, and when using 18G NCx or 19G Cx needles. OBC use reduced Ptx risk. Chest tube-requiring Ptx was significantly associated with ≥ 3 pleural passes, ≥ 3 samples, and 19G Cx needles. T1PC was most common with 17G Cx needle use and when ≥ 3 samples were obtained. Multivariate analysis showed that 18G NCx and 19G Cx needles reduced T1PC risk, while the absence of Ptx increased its likelihood.
Conclusions:
In CT-guided lung biopsies, complication risk can be reduced by optimizing technique, limiting pleural punctures and specimen numbers, and considering OBC use, needle gauge, and patient-specific factors.
To evaluate the relationship between different techniques, lesion characteristics, and the development of pneumothorax (Ptx), chest tube-requiring Ptx, and type 1 parenchymal contusion (T1PC) in computed tomographyguided transthoracic lung biopsies (CTTB).
Material and methods:
This retrospective study included 510 patients who underwent CTTB between 2015 and 2020. Patients were classified according to needle system (coaxial (Cx)/non-coaxial (NCx)), needle gauge, use of autologous blood clot (OBC), lesion size, location, approach path, pleural puncture count, number of specimens, and presence of emphysema along the needle tract. Complications were assessed with post-procedural CT. Univariate and multivariate logistic regression analyses were performed.
Results:
Ptx was more frequent in males, in the presence of emphysema along the needle tract, with middle lobe lesions, lateral approach, ≥ 3 pleural passes, ≥ 3 samples, and when using 18G NCx or 19G Cx needles. OBC use reduced Ptx risk. Chest tube-requiring Ptx was significantly associated with ≥ 3 pleural passes, ≥ 3 samples, and 19G Cx needles. T1PC was most common with 17G Cx needle use and when ≥ 3 samples were obtained. Multivariate analysis showed that 18G NCx and 19G Cx needles reduced T1PC risk, while the absence of Ptx increased its likelihood.
Conclusions:
In CT-guided lung biopsies, complication risk can be reduced by optimizing technique, limiting pleural punctures and specimen numbers, and considering OBC use, needle gauge, and patient-specific factors.
REFERENCES (37)
1.
Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018; 68: 394-424.
2.
Oberndorfer F, Müllauer L. Molecular pathology of lung cancer: current status and perspectives. Curr Opin Oncol 2018; 30: 69-76.
3.
Heerink WJ, de Bock GH, de Jonge GJ, Groen HJ, Vliegenthart R, Oudkerk M. Complication rates of CT-guided transthoracic lung biopsy: meta-analysis. Eur Radiol 2017; 27: 138-148.
4.
Goddard PR, Nicholson E, Laszlo G, Watt I. Computed tomography in pulmonary emphysema. Clin Radiol 1982; 33: 379-387.
5.
Yamagami T, Kato T, Hirota T, Yoshimatsu R, Matsumoto T, Nishimura T. Usefulness and limitation of manual aspiration immediately after pneumothorax complicating interventional radiological procedures with the transthoracic approach. Cardiovasc Intervent Radiol 2006; 29: 1027-1033.
6.
Khan M, Straub R, Moghaddam S, Maataoui A, Gurung J, Wagner T, et al. Variables affecting the risk of pneumothorax and intrapulmonal hemorrhage in CT-guided transthoracic biopsy. Eur Radiol 2008; 18: 1356-1363.
7.
Kuban JD, Tam AL, Huang SY, Ensor JE, Philip AS, Chen GJ, et al. The effect of needle gauge on the risk of pneumothorax and chest tube placement after percutaneous computed tomographic (CT)-guided lung biopsy. Cardiovasc Interv Radiol 2015; 38: 1595-1602.
8.
Nour-Eldin NEA, Alsubhi M, Emam A, Lehnert T, Beeres M, Jacobi V, et al. Pneumothorax complicating coaxial and non-coaxial CT-guided lung biopsy: comparative analysis of determining risk factors and management of pneumothorax in a retrospective review of 650 patients. Cardiovasc Interv Radiol 2016; 39: 261-270.
9.
Yeow KM, Su IH, Pan KT, Tsay PK, Lui KW, Cheung YC, et al. Risk factors of pneumothorax and bleeding: multivariate analysis of 660 CT-guided coaxial cutting needle lung biopsies. Chest 2004; 126: 748-754.
10.
Hiraki T, Mimura H, Gobara H, Shibamoto K, Inoue D, Matsui Y, 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. Am J Roentgenol 2010; 194: 809-814.
11.
Geraghty PR, Kee ST, McFarlane G, Razavi MK, Sze DY, Dake MD. CT-guided transthoracic needle aspiration biopsy of pulmonary nodules: needle size and pneumothorax rate. Radiology 2003; 229: 475-481.
12.
Kim JI, Park CM, Lee SM, Goo JM. Rapid needle-out patient-rollover approach after cone beam CT-guided lung biopsy: effect on pneumothorax rate in 1,191 consecutive patients. Eur Radiol 2015; 25: 1845-1853.
13.
Laurent F, Latrabe V, Vergier B, Montaudon M, Vernejoux JM, Dubrez J. CT-guided transthoracic needle biopsy of pulmonary nodules smaller than 20 mm: results with an automated 20-gauge coaxial cutting needle. Clin Radiol 2000; 55: 281-287.
14.
De Filippo M, Saba L, Silva M, Zagaria R, Concari G, Nizzoli R, et al. CT-guided biopsy of pulmonary nodules: is pulmonary hemorrhage a complication or an advantage? Diagn Interv Radiol 2014; 20: 421-425.
15.
Graffy P, Loomis SB, Pickhardt PJ, Lubner MG, Kitchin DR, Lee Jr FT, et al. Pulmonary intraparenchymal blood patching decreases the rate of pneumothorax-related complications following percutaneous CT-guided needle biopsy. J Vasc Interv Radiol 2017; 28: 608-613.e1. DOI: 10.1016/j.jvir.2016.12.1217.
16.
Malone LJ, Stanfill RM, Wang H, Fahey KM, Bertino RE. Effect of intraparenchymal blood patch on rates of pneumothorax and pneumothorax requiring chest tube placement after percutaneous lung biopsy. Am J Roentgenol 2013; 200: 1238-1243.
17.
Tai R, Dunne RM, Trotman-Dickenson B, Jacobson FL, Madan R, Kumamaru KK, et al. Frequency and severity of pulmonary hemorrhage in patients undergoing percutaneous CT-guided transthoracic lung biopsy: single-institution experience of 1175 cases. Radiology 2016; 279: 287-296.
18.
Yeow KM, See LC, Lui KW, Lin MC, Tsao TCY, Ng KF, et al. Risk factors for pneumothorax and bleeding after CT-guided percutaneous coaxial cutting needle biopsy of lung lesions. J Vasc Interv Radiol 2001; 12: 1305-1312.
19.
Cox JE, Chiles C, McManus CM, Aquino SL, Choplin RH. Transthoracic needle aspiration biopsy: variables that affect risk of pneumothorax. Radiology 1999; 212: 165-168.
20.
Ohno Y, Hatabu H, Takenaka D, Higashino T, Watanabe H, Ohbayashi C, et al. CT-guided transthoracic needle aspiration biopsy of small (≤ 20 mm) solitary pulmonary nodules. Am J Roentgenol 2003; 180: 1665-1669.
21.
Turgut B, Duran FM, Bakdık S, Arslan S, Tekin AF, Esme H. Effectiveness of autologous blood injection in reducing the rate of pneumothorax after percutaneous lung core needle biopsy. Diagn Interv Radiol 2020; 26: 470-475.
22.
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 2018; 83: e407-e414. DOI: 10.5114/pjr.2018.79205.
23.
Perl R, Risse E, Hetzel J, Bösmüller H, Kloth C, Fritz J, et al. The effect of intraparenchymal blood patching on the rate of pneumothorax in patients undergoing percutaneous CT-guided core biopsy of the lung. Eur J Radiol 2019; 116: 14-20.
24.
Soylu E, Ozturk K, Gokalp G, Topal U. Effect of needle-tract bleeding on pneumothorax and chest tube placement following CT guided core needle lung biopsy. J Belg Soc Radiol 2019; 103: 21. DOI: 10.5334/jbsr.1591.
25.
Lang EK, Ghavami R, Schreiner VC, Archibald S, Ramirez J. Autologous blood clot seal to prevent pneumothorax at CT-guided lung biopsy. Radiology 2000; 216: 93-96.
26.
Bourgouin P, Shepard J, McLoud T, Spizarny D, Dedrick C. Transthoracic needle aspiration biopsy: evaluation of the blood patch technique. Radiology 1988; 166: 93-95.
27.
Herman S, Weisbrod G. Usefulness of the blood patch technique after transthoracic needle aspiration biopsy. Radiology 1990; 176: 395-397.
28.
Cassel DM, Birnberg FA. Preventing pneumothorax after lung biopsy: the roll-over technique. Radiology 1990; 174: 282. DOI: 10.1148/radiology.174.1.2294564.
29.
Moore EH, LeBlanc J, Montesi SA, Richardson ML, Shepard JA, McLoud TC. Effect of patient positioning after needle aspiration lung biopsy. Radiology 1991; 181: 385-387.
30.
Yankelevitz DF, Davis SD, Henschke CI. Aspiration of a large pneumothorax resulting from transthoracic needle biopsy. Radiology 1996; 200: 695-697.
31.
Yamagami T, Nakamura T, Iida S, Kato T, Nishimura T. Management of pneumothorax after percutaneous CT-guided lung biopsy. Chest 2002; 121: 1159-1164.
32.
Wagner JM, Hinshaw JL, Lubner MG, Robbins JB, Kim DH, Pickhardt PJ, et al. CT-guided lung biopsies: pleural blood patching reduces the rate of chest tube placement for postbiopsy pneumothorax. Am J Roentgenol 2011; 197: 783-788.
33.
Nour-Eldin N-EA, Alsubhi M, Naguib NN, Lehnert T, Emam A, Beeres M, et al. Risk factor analysis of pulmonary hemorrhage complicating CT-guided lung biopsy in coaxial and non-coaxial core biopsy techniques in 650 patients. Eur J Radiol 2014; 83: 1945-1952.
34.
Wattanasatesiri T, Puntu W, Vithitsuvanakul N. Influencing factors of pneumothorax and parenchymal haemorrhage after CT-guided transthoracic needle biopsy: single-institution experience. Pol J Radiol 2018; 83: 379-388.
35.
Topala U, Berkmanb YM. Effect of needle tract bleeding on occurrence of pneumothorax after transthoracic needle biopsy. Eur J Radiol 2005; 53: 495-499.
36.
Furmaga-Rokou O, Michailidis A, Dimou G, Kosmolaptsis P, Zlika S, Giankoulof C, et al. A case report of life-threatening hemothorax after percutaneous lung biopsy successfully managed with embolization. Radiol Case Rep 2023; 18: 2939-2942.
37.
Huang WM, Lin HC, Chen CH, Chen CW, Wang CH, Huang CY, et al. Massive hemothorax after computed tomography-guided lung tumor biopsy: an unusual but disastrous complication. Thorac Cancer 2018; 9: 892-896.
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