title: Risk factors for pneumothorax and bleeding after CT-guided percutaneous coaxial cutting needle biopsy of lung lesions.
abstract: OBJECTIVE
  To evaluate risk factors for pneumothorax and bleeding after computed tomography (CT)-guided percutaneous coaxial cutting needle biopsy of lung lesions.
  
  
  METHODS
  This study involved 117 consecutive patients with 117 intrapulmonary lesions. Statistical analysis of factors related to patient characteristics, lung lesions, and biopsy technique was performed to determine possible contribution to the occurrence of pneumothorax and bleeding. Interactions between related factors were considered to prevent colinearity.
  
  
  RESULTS
  Pneumothorax occurred in 12% (14 of 117) of patients. Needle aspiration of two moderate asymptomatic pneumothoraces were performed; there was no chest tube insertion. Lesion depth (P =.0097), measured from the pleural puncture site to the edge of the intrapulmonary lesion along the needle path, was the single significant predictor of pneumothorax. The highest risk of pneumothorax occurred in subpleural lesions 2 cm or shorter in depth (this represented 33% of lung lesions but caused 71% of all pneumothoraces; OR = 7.1; 95% CI, 1.3-50.8). Bleeding presented as lung parenchyma hemorrhage and hemoptysis in 30 patients (26%). Hemoptysis occurred in four patients (3%). Univariate analysis identified lesion depth (P <.0001), lesion size (P <.015), and pathology type (P =.007) as risk factors for bleeding. Multivariate logistic regression analysis identified lesion depth as the most important risk factor, with the highest bleeding risk for lesions more than 2 cm deep (14% of lesions caused 46% of all bleeding; OR = 17.3; 95% CI, 3.3-121.4).
  
  
  CONCLUSIONS
  In CT-guided coaxial cutting needle biopsy, lesion depth is the single predictor for risk of pneumothorax, which occurs at the highest rate in subpleural lesions. Increased risk of bleeding occurs in lesions deeper than 2 cm.
authors.affiliation: Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chang Gung University, Taiwan, Republic of China. kmyeow@adm.cgmh.org.tw
authors.forename: K M
authors.initials: KM
authors.lastname: Yeow
authors.forename: L C
authors.initials: LC
authors.lastname: See
authors.forename: K W
authors.initials: KW
authors.lastname: Lui
authors.forename: M C
authors.initials: MC
authors.lastname: Lin
authors.forename: T C
authors.initials: TC
authors.lastname: Tsao
authors.forename: K F
authors.initials: KF
authors.lastname: Ng
authors.forename: H P
authors.initials: HP
authors.lastname: Liu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006469:Hemoptysis / Q000209:etiology* / Q000628:therapy; D006801:Humans; D016015:Logistic Models; D008171:Lung Diseases / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011030:Pneumothorax / Q000209:etiology* / Q000628:therapy; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed