title: Complications from computed tomography-guided core needle biopsy for patients receiving stereotactic body radiation therapy for early-stage lesions of the lung.
abstract: BACKGROUND
  Obtaining a tissue diagnosis has traditionally been standard practice before initiating therapy for early-stage non-small-cell lung cancer (NSCLC). In several recent studies from Europe and Asia, a substantial proportion of patients have received stereotactic body radiation therapy (SBRT) based only on the imaging characteristics of the suspicious lesion. The underlying assumption is that the risk of percutaneous needle biopsy may outweigh the benefits in a population that generally has underlying pulmonary dysfunction and other medical comorbidity. Nevertheless, there is limited information regarding biopsy-related complication rates in high-risk patients with early-stage NSCLC who are treated with SBRT.
  
  
  METHODS
  This was a retrospective review of outcomes after biopsy in patients treated with SBRT. Complications of percutaneous core needle biopsy were analyzed in relation to patient and tumor characteristics. Each biopsy event was analyzed independently for patients with multiple biopsies.
  
  
  RESULTS
  A total of 112 percutaneous biopsies were performed in 103 patients. Pneumothorax of any degree was observed in 40 patients (35%) (95% CI, 27%-45%), and 12 patients (10.7%) had a clinically significant pneumothorax requiring chest tube placement (95% CI, 6%-18%). The time to first fraction of SBRT was not different in patients who had a pneumothorax or placement of a chest tube. On multivariate analysis, age, performance status, smoking history, pack-years of smoking, chronic obstructive pulmonary disease history, and forced expiratory volume in the first second of expiration were not statistically significantly associated with chest tube placement.
  
  
  CONCLUSIONS
  Computed tomography-guided needle biopsy in a primarily medically inoperable patient population is safe, with an acceptable degree of complications.
authors: State University of New York Upstate Medical University, Syracuse, NY. Electronic address: ChowdhrV@upstate.edu.
authors: Varun K
authors: VK
authors: Chowdhry
authors: University of Rochester, Rochester, NY.
authors: Amit K
authors: AK
authors: Chowdhry
authors: Albany Medical College, Albany, NY.
authors: Nathan
authors: N
authors: Goldman
authors: State University of New York Upstate Medical University, Syracuse, NY.
authors: Ernest M
authors: EM
authors: Scalzetti
authors: State University of New York Upstate Medical University, Syracuse, NY.
authors: Rolf A
authors: RA
authors: Grage
authors: State University of New York Upstate Medical University, Syracuse, NY.
authors: Jeffrey A
authors: JA
authors: Bogart
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D062005:Biopsy, Large-Core Needle / Q000009:adverse effects; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis* / Q000473:pathology / Q000532:radiotherapy; D015505:Chest Tubes / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D061705:Image-Guided Biopsy / Q000009:adverse effects; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology*; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000532:radiotherapy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011030:Pneumothorax / Q000209:etiology; D016634:Radiosurgery; D012189:Retrospective Studies; D012306:Risk; D014057:Tomography, X-Ray Computed
keywords: Diagnosis; Lung cancer; Radiotherapy