title: Is emphysema a risk factor for pneumothorax in CT-guided lung biopsy?
abstract: BACKGROUND
  Computed tomography (CT)-guided lung biopsy is commonly used to make a histological diagnosis for pulmonary lesions. Its most common complication is pneumothorax. While it is thought that CT-guided lung biopsy should be avoided in patients with emphysema, however, there is no scientific report documenting the relationship the occurrence of pneumothorax and the severity of emphysema.
  
  
  OBJECTIVE
  To investigate the relationship between the severity of emphysema and the frequency of pneumothorax, we retrospectively reviewed all the patients who received CT-guided lung biopsy. Severity of emphysema is evaluated by Goddard classification, a visual scale by which areas of vascular disruption and low attenuation value were scored for each lung field of high resolution CT. Patients' characteristics, prognostic accuracy of this method, size and location of the lesion, length of intrapulmonary biopsy paths, and frequency of complications such as pneumothorax or intrapulmonary hemorrhage were evaluated.
  
  
  RESULTS
  One hundred-two patients (69 males and 33 females) received 102 procedures. Diagnostic accuracy was 90.2%. Pneumothorax occurred in 41 of 102 biopsies (40.2%). Chest tube placement was required in 3 out of the 41 cases (7.3%) complicated by pneumothorax (2.9% of all the biopsies). The longer lesion depths from pleura were, the more frequently pneumothorax occurred (6.67 vs 3.66 mm, p=0.019). No correlation was found between location of lesions and frequency of pneumothorax. No significant differences of COPD staging or LAA score were seen between the patients with and without pneumothorax (5.73 vs 4.32 points, p=0.339).
  
  
  CONCLUSIONS
  We suggest that severity of emphysema such as stage I or II COPD may not be related to the frequency of pneumothorax.
authors.affiliation: Department of Pulmonology, Kameda Medical Center, Zip296-8602 929 higashi-cho, kamogawa-city, Chiba, Japan ; Department of Internal Medicine, Division of Respiratory Medicine and Allergology, Aichi Medical University School of Medicine, Aichi, Japan.
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Asai
authors.forename: Yasutaka
authors.initials: Y
authors.lastname: Kawamura
authors.forename: Ikuo
authors.initials: I
authors.lastname: Yamazaki
authors.forename: Keiji
authors.initials: K
authors.lastname: Sogawa
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Ohkuni
authors.forename: Toshihiro
authors.initials: T
authors.lastname: O'uchi
authors.forename: Akihito
authors.initials: A
authors.lastname: Kubo
authors.forename: Etsuro
authors.initials: E
authors.lastname: Yamaguchi
authors.forename: Norihiro
authors.initials: N
authors.lastname: Kaneko
keywords: CT-guided percutaneous lung biopsy; Emphysema; Pneumothorax