title: Risk factor analysis of pulmonary hemorrhage complicating CT-guided lung biopsy in coaxial and non-coaxial core biopsy techniques in 650 patients.
abstract: OBJECTIVE
  To evaluate the risk factors involved in the development of pulmonary hemorrhage complicating CT-guided biopsy of pulmonary lesions in coaxial and non-coaxial techniques.
  
  
  METHODS
  Retrospective study included CT-guided percutaneous lung biopsies in 650 consecutive patients (407 males, 243 females; mean age 54.6 years, SD: 5.2) from November 2008 to June 2013. Patients were classified according to lung biopsy technique in coaxial group (318 lesions) and non-coaxial group (332 lesions). Exclusion criteria for biopsy were: lesions <5mm in diameter, uncorrectable coagulopathy, positive-pressure ventilation, severe respiratory compromise, pulmonary arterial hypertension or refusal of the procedure. Risk factors for pulmonary hemorrhage complicating lung biopsy were classified into: (a) patient's related risk factors, (b) lesion's related risk factors and (d) technical risk factors. Radiological assessments were performed by two radiologists in consensus. Mann-Whitney U test and Fisher's exact tests for statistical analysis. p values <0.05 were considered statistically significant.
  
  
  RESULTS
  Incidence of pulmonary hemorrhage was 19.6% (65/332) in non-coaxial group and 22.3% (71/318) in coaxial group. The difference in incidence between both groups was statistically insignificant (p=0.27). Hemoptysis developed in 5.4% (18/332) and in 6.3% (20/318) in the non-coaxial and coaxial groups respectively. Traversing pulmonary vessels in the needle biopsy track was a significant risk factor of the development pulmonary hemorrhage (incidence: 55.4% (36/65, p=0.0003) in the non-coaxial group and 57.7% (41/71, p=0.0013) in coaxial group). Other significant risk factors included: lesions of less than 2 cm (p value of 0.01 and 0.02 in non-coaxial and coaxial groups respectively), basal and middle zonal lesions in comparison to upper zonal lung lesions (p=0.002 and 0.03 in non-coaxial and coaxial groups respectively), increased lesion's depth from the pleural surface (p=0.021 and 0.018 in non-coaxial and coaxial groups respectively), increased distance of traversed lung in the needle track of more than 2.5 cm (p=0.001 in both groups). Insignificant risk factors were patient's age, gender or emphysema in both groups (p value >0.1 in both groups). Concomitant incidence of pneumothorax was 32.3% (21/65) in non-coaxial group and 36.6% (26/71) in coaxial group. Pulmonary hemorrhage in the majority of cases was treated conservatively.
  
  
  CONCLUSIONS
  Pulmonary hemorrhage complicating CT-guided core biopsy of pulmonary lesions, showed insignificant difference between coaxial and non-coaxial techniques. Significant risk factors of pulmonary hemorrhage included small and basal lesions, increased lesion's depth from pleural surface, increased length of aerated lung parenchyma crossed by biopsy needle and passing through vessels within the lung during puncture.
authors: Institute for Diagnostic and Interventional Radiology, Johan Wolfgang Goethe - University Hospital, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; Diagnostic and Interventional Radiology Department, Cairo University Hospital, Cairo, Egypt. Electronic address: nour410@hotmail.com.
authors: Nour-Eldin A
authors: NE
authors: Nour-Eldin
authors: Institute for Diagnostic and Interventional Radiology, Johan Wolfgang Goethe - University Hospital, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany.
authors: Mohammed
authors: M
authors: Alsubhi
authors: Institute for Diagnostic and Interventional Radiology, Johan Wolfgang Goethe - University Hospital, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; Diagnostic and Interventional Radiology Department, Alexandria University Hospital, Alexandria, Egypt.
authors: Nagy N
authors: NN
authors: Naguib
authors: Institute for Diagnostic and Interventional Radiology, Johan Wolfgang Goethe - University Hospital, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany.
authors: Thomas
authors: T
authors: Lehnert
authors: Institute for Diagnostic and Interventional Radiology, Johan Wolfgang Goethe - University Hospital, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany.
authors: Ahmed
authors: A
authors: Emam
authors: Institute for Diagnostic and Interventional Radiology, Johan Wolfgang Goethe - University Hospital, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany.
authors: Martin
authors: M
authors: Beeres
authors: Institute for Diagnostic and Interventional Radiology, Johan Wolfgang Goethe - University Hospital, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany.
authors: Boris
authors: B
authors: Bodelle
authors: Institute for Diagnostic and Interventional Radiology, Johan Wolfgang Goethe - University Hospital, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany.
authors: Karen
authors: K
authors: Koitka
authors: Institute for Diagnostic and Interventional Radiology, Johan Wolfgang Goethe - University Hospital, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany.
authors: Thomas J
authors: TJ
authors: Vogl
authors: Institute for Diagnostic and Interventional Radiology, Johan Wolfgang Goethe - University Hospital, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany.
authors: Volkmar
authors: V
authors: Jacobi
mesh_terms: D000328:Adult; D000368:Aged; D062005:Biopsy, Large-Core Needle; D005260:Female; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D008171:Lung Diseases / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015641:Radiography, Interventional; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
keywords: Biopsy; CT-guided; Coaxial; Hemorrhage; Lung; Non-coaxial