title: Risk assessment of pneumothorax and pulmonary haemorrhage complicating percutaneous co-axial cutting needle lung biopsy.
abstract: BACKGROUND
  The primary aim of this study was to evaluate the ability of radiologists to accurately estimate pneumothorax and pulmonary haemorrhage during percutaneous co-axial cutting needle CT-guided lung biopsy.
  
  
  METHODS
  Patients undergoing cutting needle lung biopsy during the study period were identified; the path taken by the cutting needle marked on each pre-biopsy staging CT scan. Each scan was then reviewed independently by two thoracic radiologists blinded to clinical details and complications; pneumothorax and pulmonary haemorrhage risk estimated with a percentage Visual Analogue Scale.
  
  
  RESULTS
  In 134 patients, pneumothorax occurred in 24%. The radiologists differed in the estimation of pneumothorax risk in 55% (74 episodes). When pneumothorax risk was estimated <20% by radiologists 1 and 2, 16% and 14% of biopsies resulted in pneumothorax; where risk was estimated at 20-49%, pneumothorax incidence rose to 33% and 31%; where risk was deemed > or =50%, pneumothorax rate was 87% and 100%. Pulmonary haemorrhage occurred in 4%; estimated haemorrhage risk for biopsies complicated by haemorrhage did not differ significantly from where haemorrhage did not occur.
  
  
  CONCLUSIONS
  Radiologists differ markedly in the estimation of pneumothorax risk for a patient undergoing co-axial lung biopsy. Identifying individual patients developing pneumothorax was only possible when risk was estimated at > or =50%. Pulmonary haemorrhage was uncommon and difficult to predict accurately.
authors.affiliation: Clinical Sciences Centre, University of Liverpool, UK. biz@doctors.org.uk
authors.forename: Biswajit
authors.initials: B
authors.lastname: Chakrabarti
authors.forename: John E
authors.initials: JE
authors.lastname: Earis
authors.forename: Rakesh
authors.initials: R
authors.lastname: Pandey
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Jones
authors.forename: Kirsty
authors.initials: K
authors.lastname: Slaven
authors.forename: Suzanne
authors.initials: S
authors.lastname: Amin
authors.forename: Caroline
authors.initials: C
authors.lastname: McCann
authors.forename: Phillip L
authors.initials: PL
authors.lastname: Jones
authors.forename: Erica
authors.initials: E
authors.lastname: Thwaite
authors.forename: John M
authors.initials: JM
authors.lastname: Curtis
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Warburton
mesh_terms: D000368:Aged; D001707:Biopsy, Needle / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006469:Hemoptysis / Q000000981:diagnostic imaging / Q000209:etiology*; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology*; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011030:Pneumothorax / Q000000981:diagnostic imaging / Q000209:etiology*; D015641:Radiography, Interventional / Q000379:methods; D018570:Risk Assessment / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000379:methods