title: Computer tomography-guided core biopsies in a county hospital in Sweden: Complication rate and diagnostic yield.
abstract: BACKGROUND
  Core biopsies are valuable in obtaining sufficient tissue to ensure diagnosis of diseases in the thorax.
  
  
  OBJECTIVE
  To evaluate the complication rate and the diagnostic yield in computer tomography (CT)-guided core biopsies performed in a county hospital in Sweden.
  
  
  METHODS
  Medical journals, spirometry results, pathology reports and CT scans were reviewed in 463 consecutive cases, where a transthoracic core biopsy was performed between January 2005 and December 2010. Of these 380 (82%) were lung lesions, 48 (10%) were mediastinal lesions and 35 (8%) were pleural lesions.
  
  
  RESULTS
  All patients underwent a chest X-ray 4 hours post-biopsy and pneumothorax was seen in 156/463 (34%) patients: 137 after lung biopsy and 17 after mediastinal biopsy. Chest tube insertion was required for 27 (17%) of these patients (6% of all core biopsies). Small intraparenchymal hemorrhages and hemoptysis were observed with subjective difficulty in one case. The diagnostic yield for the 463 patients was 212 (46%) cases of lung cancer, 188 (41%) benign lesions and 39 (8%) pulmonary metastases.
  
  
  CONCLUSIONS
  A transthoracic core biopsy ensures diagnosis with a low complication rate and is suitable as an outpatient procedure. An increased risk for pneumothorax was observed when the biopsied lesion was small or when emphysema was in the path of the biopsy needle. Reduced lung function pre-biopsy or emphysema in the path of the biopsy needle increased the need for chest tube treatment of pneumothorax. A CT-guided core biopsy is safe and applicable in a county hospital.
authors.affiliation: Department of Respiratory Medicine, Gävle Hospital, Karolinska Institutet, Stockholm, Sweden ; Centre for Research and Development Uppsala University/County Council of Gävleborg, Sweden ; Karolinska Institutet, Stockholm, Sweden.
authors.forename: Eva
authors.initials: E
authors.lastname: Brandén
authors.affiliation: Department of Radiology, Gävle Hospital, Gävle, Sweden.
authors.forename: Stig
authors.initials: S
authors.lastname: Wallgren
authors.affiliation: Centre for Research and Development Uppsala University/County Council of Gävleborg, Sweden ; Department of Public Health Medicine, County Council of Gävleborg, Sweden.
authors.forename: Hans
authors.initials: H
authors.lastname: Högberg
authors.affiliation: Department of Respiratory Medicine, Gävle Hospital, Karolinska Institutet, Stockholm, Sweden ; Centre for Research and Development Uppsala University/County Council of Gävleborg, Sweden ; Karolinska Institutet, Stockholm, Sweden.
authors.forename: Hirsh
authors.initials: H
authors.lastname: Koyi
keywords: Core biopsies; FEV1; emphysema; hemorrhage; pneumothorax