title: Trends in use and safety of image-guided transthoracic needle biopsies in patients with cancer.
abstract: OBJECTIVE
  Image-guided transthoracic needle biopsy (IGTTNB) is an important tool in the diagnosis of patients with cancer. Common complications include pneumothorax and chest tube placement, with rates ranging from 6% to 57%. We performed a population-based study to determine patterns of use, complications, and costs associated with IGTTNB.
  
  
  METHODS
  The Premier Perspective database was used to identify patients with cancer with ≥ one claim for IGTTNB from 2006 to 2012. Patients were stratified on the basis of inpatient versus outpatient setting. Pneumothorax was defined by a new claim within 1 month of IGTTNB; hospitalization and chest tube placement rates were analyzed. Multivariable analysis was used to identify factors associated with pneumothorax.
  
  
  RESULTS
  We Identified 79,518 patients with cancer who underwent IGTTNB: 42,955 (54.0%) outpatients and 36,563 (46.0%) inpatients. Of patients who underwent outpatient IGTTNB, 5,261 (12.2%) developed a pneumothorax. Of those, 1,006 (19.1%, 2.3% of total) were hospitalized, and 180 (3.4%, 0.42% of total) required chest tubes. Pneumothorax after outpatient IGTTNB was associated with number of comorbidities, rural site, hospital bed size of more than 600, and biopsy of parenchymal as opposed to pleural lesions. Of patients who underwent inpatient IGTTNB, 7,830 (21.4%) developed a pneumothorax, and 2,894 (36.0%, 7.9% of total) required chest tube. Over time, total IGTTNB volume increased by 40.6%, and mean outpatient cost per procedure increased by 24.4%.
  
  
  CONCLUSIONS
  While pneumothorax was frequent in outpatients, rates of hospitalization and chest tube placement were low. As screening for lung cancer increases, we anticipate an increased need for IGTNBB. Patients can be reassured by the low rate of serious complications.
authors.affiliation: Columbia University College of Physicians and Surgeons; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons; and Mailman School of Public Health, Columbia University, New York, NY.
authors.forename: Melissa K
authors.initials: MK
authors.lastname: Accordino
authors.affiliation: Columbia University College of Physicians and Surgeons; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons; and Mailman School of Public Health, Columbia University, New York, NY.
authors.forename: Jason D
authors.initials: JD
authors.lastname: Wright
authors.affiliation: Columbia University College of Physicians and Surgeons; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons; and Mailman School of Public Health, Columbia University, New York, NY.
authors.forename: Donna
authors.initials: D
authors.lastname: Buono
authors.affiliation: Columbia University College of Physicians and Surgeons; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons; and Mailman School of Public Health, Columbia University, New York, NY.
authors.forename: Alfred I
authors.initials: AI
authors.lastname: Neugut
authors.affiliation: Columbia University College of Physicians and Surgeons; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons; and Mailman School of Public Health, Columbia University, New York, NY dlh23@columbia.edu.
authors.forename: Dawn L
authors.initials: DL
authors.lastname: Hershman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends*; D001707:Biopsy, Needle / Q000009:adverse effects / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends*; D015505:Chest Tubes; D016009:Chi-Square Distribution; D016208:Databases, Factual; D005260:Female; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics / Q000639:trends*; D006801:Humans; D061705:Image-Guided Biopsy / Q000009:adverse effects / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends*; D016015:Logistic Models; D008175:Lung Neoplasms / Q000473:pathology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011030:Pneumothorax / Q000209:etiology / Q000628:therapy; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors; D013997:Time Factors