Dependent lesion positioning at CT-guided lung biopsy to reduce risk of pneumothorax

被引:21
作者
Appel, Elisabeth [1 ,2 ]
Dommaraju, Sujithraj [1 ]
Camacho, Andres [1 ]
Nakhaei, Masoud [1 ]
Siewert, Bettina [1 ]
Ahmed, Muneeb [1 ]
Brook, Alexander [1 ]
Brook, Olga R. [1 ]
机构
[1] Beth Israel Deaconess Med Ctr, Dept Radiol, 1 Deaconess Rd, Boston, MA 02215 USA
[2] Univ Dusseldorf, Med Fac, Dept Diagnost & Intervent Radiol, Moorenstr 5, D-40225 Dusseldorf, Germany
关键词
Pneumothorax; Lung; Biopsy; Patient positioning; Tomography; X-ray computed; TRANSTHORACIC NEEDLE-BIOPSY; COMPLICATIONS; NODULE;
D O I
10.1007/s00330-020-07025-y
中图分类号
R8 [特种医学]; R445 [影像诊断学];
学科分类号
1002 ; 100207 ; 1009 ;
摘要
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.
引用
收藏
页码:6369 / 6375
页数:7
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