Complications of thoracic computed tomography-guided fiducial placement for the purpose of stereotactic body radiation therapy.
OBJECTIVE
This study examined the complication rates associated with percutaneous fiducial placement for the purpose of stereotactic body radiation therapy of primary and metastatic lung neoplasms.


METHODS
This is a retrospective review of computed tomography (CT) scans and follow-up chest radiographs of 48 consecutive patients who underwent CT-guided percutaneous fiducial placement. The effect of age, sex, number of fiducials placed, and performance of a concomitant biopsy on the complication rates were assessed.


RESULTS
Of 48 patients with a total of 221 fiducials placed, 16 (33%) had a procedure-related pneumothorax. There was no significant difference in pneumothorax rate based on age (P = 0.16), sex (P > 0.99), and number of fiducials placed (P = 0.21). Overall, 6 of 48 patients (12.5%) required a thoracostomy tube. Performance of a concomitant core needle biopsy at the time of fiducial placement was associated with pneumothorax rates of 64% compared with 26% without biopsies (P = 0.03). Postprocedural CT demonstrated hemorrhage in 9 patients (19%). Two patients had hemoptysis; one required admission. Patients' age, sex, number of fiducials placed, and performance of concomitant biopsy had no statistically significant implications on parenchymal hemorrhage incidence.


CONCLUSIONS
Approximately one third of the patients develop a pneumothorax during CT-guided fiducial placement. Most are asymptomatic and do not require a thoracostomy. A concurrent biopsy at the time of fiducial placement is associated with an increased risk of pneumothorax. Hemorrhage occurs but is usually clinically insignificant.
Yousefi
Shadi
S
Department of Radiology, Georgetown University Hospital, Washington, DC 20007-2113, USA.
Collins
Brian T
BT
Reichner
Cristina A
CA
Anderson
Eric D
ED
Jamis-Dow
Carlos
C
Gagnon
Gregory
G
Malik
Shakun
S
Marshall
Blair
B
Chang
Thomas
T
Banovac
Filip
F
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011030:Pneumothorax / Q000209:etiology; D013902:Radiography, Thoracic; D016634:Radiosurgery / Q000009:adverse effects* / Q000379:methods; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed