1Tanya Tyagi, 1Narinder Kaur
1Government Medical College and Hospital, Chandigarh, India
CT guided lung biopsy is a well established method in the diagnosis of lung lesions, however it comes with a few known complications. This study was done to evaluate the rate of complications and assess the influence of various variables on the occurrence of pneumothorax and pulmonary hemorrhage in CT guided transthoracic needle biopsy.
Material(s) and Method(s):
This prospective study involved 40 patients who had indeterminate pulmonary nodule/mass on chest x-ray/CT and underwent CT guided transthoracic lung biopsy using coaxial biopsy set in our hospital. Incidence of post procedure complications like pneumothorax and pulmonary hemorrhage was seen and the effect of various patient, lesion and procedure related factors on the frequency of complications was evaluated. Special emphasis on procedural factors like dwell time and needle-pleural angle was analysed. The risk factors were determined using univariate analysis of variables
Pneumothorax occurred in 22.5% (9/40) of patients. The risk factors associated with post biopsy pneumothorax were depth from pleura (p = 0.049), dwell time (p = 0.001) and needle pleural angle (p = 0.020). Pulmonary hemorrhage occurred in 35% (14/40) of patients. Increased incidence of pulmonary hemorrhage had a statistically significant correlation with dwell time (p =0.023), depth from pleura (p =0.041) and patients in supine position (p =0.05).
This study demonstrated a significant effect of the depth of the lesion, needle-pleural angle and dwell time on the incidence of post-procedural pneumothorax. Needle gauge, emphysema, gender of the patient, site of the lesion, and operator experience had no effect on complication 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 transthoracic needle biopsy.