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      Predictors of Technical Success and Rate of Complications of Image-Guided Percutaneous Transthoracic Lung Needle Biopsy of Pulmonary Tumors

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          Abstract

          Purpose

          To investigate predictors of technical success and complications of computed tomography (CT)-guided percutaneous transthoracic needle biopsy of potentially malignant pulmonary tumors.

          Material and Methods

          From 2008 to 2009, technical success and rate of complications of CT-guided percutaneous transthoracic lung needle biopsies of patients with suspicious pulmonary tumors were retrospectively evaluated. The influence on technical success and rate of complications was assessed for intervention-related predictors (lesion diameter, length of biopsy pathway, number of pleural transgressions, and needle size) and patient-related predictors (age, gender, reduced lung function). In addition, technical success and rate of complications were compared between different interventional radiologists.

          Results

          One hundred thirty-eight patients underwent biopsies by 15 interventional radiologists. The overall technical success rate was 84.1% and was significantly different between interventional radiologists (range 25%-100%; p<0.01). Intervention-related and patient-related predictors did not influence the technical success rate. The overall complication rate was 59.4% with 39.1% minor complications and 21.0% major complications. The rate of complications was influenced by lesion diameter and distance of biopsy pathway. Interventional radiologist-related rates of complications were not statistically different.

          Conclusions

          Technical success of percutaneous, transthoracic lung needle biopsies of pulmonary tumors is probably dependent on the interventional radiologist. In addition, lesion diameter and length of biopsy pathway are predictors of the rate of complications.

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          Population-based risk for complications after transthoracic needle lung biopsy of a pulmonary nodule: an analysis of discharge records.

          Renda Wiener, Lisa M Schwartz, Steven Woloshin … (2011)
          Because pulmonary nodules are found in up to 25% of patients undergoing computed tomography of the chest, the question of whether to perform biopsy is becoming increasingly common. Data on complications after transthoracic needle lung biopsy are limited to case series from selected institutions. To determine population-based estimates of risks for complications after transthoracic needle biopsy of a pulmonary nodule. Cross-sectional analysis. The 2006 State Ambulatory Surgery Databases and State Inpatient Databases for California, Florida, Michigan, and New York from the Healthcare Cost and Utilization Project. 15 865 adults who had transthoracic needle biopsy of a pulmonary nodule. Percentage of biopsies complicated by hemorrhage, any pneumothorax, or pneumothorax requiring a chest tube, and adjusted odds ratios for these complications associated with various biopsy characteristics, calculated by using multivariate, population-averaged generalized estimating equations. Although hemorrhage was rare, complicating 1.0% (95% CI, 0.9% to 1.2%) of biopsies, 17.8% (CI, 11.8% to 23.8%) of patients with hemorrhage required a blood transfusion. In contrast, the risk for any pneumothorax was 15.0% (CI, 14.0% to 16.0%), and 6.6% (CI, 6.0% to 7.2%) of all biopsies resulted in pneumothorax requiring a chest tube. Compared with patients without complications, those who experienced hemorrhage or pneumothorax requiring a chest tube had longer lengths of stay (P < 0.001) and were more likely to develop respiratory failure requiring mechanical ventilation (P = 0.020). Patients aged 60 to 69 years (as opposed to younger or older patients), smokers, and those with chronic obstructive pulmonary disease had higher risk for complications. Estimated risks may be inaccurate if coding of complications is incomplete. The analyzed databases contain little clinical detail (such as information on nodule characteristics or biopsy pathology) and cannot indicate whether performing the biopsy produced useful information. Whereas hemorrhage is an infrequent complication of transthoracic needle lung biopsy, pneumothorax is common and often necessitates chest tube placement. These population-based data should help patients and physicians make more informed choices about whether to perform biopsy of a pulmonary nodule. Department of Veterans Affairs and National Cancer Institute.
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            Complications of CT-guided percutaneous needle biopsy of the chest: prevention and management.

            Alex Wu, Michael Maher, Jo-Anne Shepard (2011)
            The objective of this article is to describe potential complications of percutaneous needle biopsy of the chest, discuss the risk factors associated with the development of complications, and explain how to prevent complications and manage complications when they occur. Pneumothorax and pulmonary hemorrhage are the most common complications of percutaneous needle biopsy of the chest, whereas air embolism and tumor seeding are extremely rare. Attention to biopsy planning and technique and postprocedural care help to prevent or minimize most potential complications.
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              Comparison of endobronchial ultrasound, positron emission tomography, and CT for lymph node staging of lung cancer.

              Ken Motoori, Takehiko Fujisawa, Takahiro Nakajima … (2006)
              To perform a prospective comparison of direct real-time endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA), positron emission tomography (PET), and thoracic CT for detection of mediastinal and hilar lymph node metastasis in patients with lung cancer considered for surgical resection. Prospective patient enrollment. University teaching hospital. One hundred two potentially operable patients with proven (n = 96) or radiologically suspected (n = 6) lung cancer were included in the study. CT, PET, and EBUS-TBNA were performed prior to surgery for the evaluation of mediastinal and hilar lymph node metastasis. The convex probe EBUS, which is integrated with a convex scanning probe on its tip, was used for EBUS-TBNA. Surgical histology was used as the "gold standard" to confirm lymph node metastasis unless patients were found inoperable for N3 or extensive N2 disease proven by EBUS-TBNA. EBUS-TBNA was successfully performed in all 102 patients (mean age, 67.8 years) from 147 mediastinal and 53 hilar lymph nodes. EBUS-TBNA proved malignancy in 37 lymph node stations in 24 patients. CT identified 92 positive lymph nodes, and PET identified 89 positive lymph nodes (4 supraclavicular, 63 mediastinal, 22 hilar). The sensitivities of CT, PET, and EBUS-TBNA for the correct diagnosis of mediastinal and hilar lymph node staging were 76.9%, 80.0%, and 92.3%, respectively; specificities were 55.3%, 70.1%, and 100%, and diagnostic accuracies were 60.8%, 72.5%, and 98.0%. EBUS-TBNA was uneventful, and there were no complications. Compared to CT and PET, EBUS-TBNA has a high sensitivity as well as specificity for mediastinal and hilar lymph node staging in patients with lung cancer. EBUS-TBNA should be considered for evaluation of the mediastinum early in the staging process of lung cancer.
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                Author and article information

                Contributors
                Robert L Schmidt: Role: Academic Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (iso-abbrev): PLoS ONE
                Journal ID (publisher-id): plos
                Journal ID (pmc): plosone
                Title: PLoS ONE
                Publisher: Public Library of Science (San Francisco, CA USA )
                ISSN (Electronic): 1932-6203
                Publication date (Electronic): 9 April 2015
                Publication date Collection: 2015
                Volume: 10
                Issue: 4
                Electronic Location Identifier: e0124947
                Affiliations
                [1 ]Department of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
                [2 ]Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
                [3 ]Department of Surgery, Division of General, Visceral, Thoracic and Vascular Surgery, University Medicine Greifswald, Greifswald, Germany
                University of Utah Health Sciences Center, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: JPK SO BM SS CM. Performed the experiments: JPK SO BM SS CM KB. Analyzed the data: JPK SO NF. Contributed reagents/materials/analysis tools: JPK SO NF WB. Wrote the paper: SO BM NF CM WB SS NH JPK.

                Article
                Publisher ID: PONE-D-15-03970
                DOI: 10.1371/journal.pone.0124947
                PMC ID: 4391827
                PubMed ID: 25855983
                SO-VID: d10b1560-d75a-4243-b9cb-3a52dba77cfc
                Copyright statement: Copyright @ 2015
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

                History
                Date received : 27 January 2015
                Date accepted : 20 March 2015
                Page count
                Figures: 4, Tables: 1, Pages: 9
                Funding
                The authors have no support or funding to report.
                Categories
                Subject: Research Article
                Custom metadata
                Data Availability All relevant data are within the paper.

                ScienceOpen disciplines: Uncategorized
                Data availability:
                ScienceOpen disciplines: Uncategorized

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