Risk assessment of pneumothorax and pulmonary haemorrhage complicating percutaneous co-axial cutting needle lung biopsy.
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.
Chakrabarti
Biswajit
B
Clinical Sciences Centre, University of Liverpool, UK. biz@doctors.org.uk
Earis
John E
JE
Pandey
Rakesh
R
Jones
Yvonne
Y
Slaven
Kirsty
K
Amin
Suzanne
S
McCann
Caroline
C
Jones
Phillip L
PL
Thwaite
Erica
E
Curtis
John M
JM
Warburton
Christopher J
CJ
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