title: Rapid needle-out patient-rollover approach after cone beam CT-guided lung biopsy: effect on pneumothorax rate in 1,191 consecutive patients.
abstract: OBJECTIVE
  To investigate the effect of rapid needle-out patient-rollover approach on the incidence of pneumothorax and drainage catheter placement due to pneumothorax in C-arm Cone-beam CT (CBCT)-guided percutaneous transthoracic needle biopsy (PTNB) of lung lesions.
  
  
  METHODS
  From May 2011 to December 2012, 1227 PTNBs were performed in 1191 patients with a 17-gauge coaxial needle. 617 biopsies were performed without (conventional-group) and 610 with rapid-rollover approach (rapid-rollover-group). Overall pneumothorax rates and incidences of pneumothorax requiring drainage catheter placement were compared between two groups.
  
  
  RESULTS
  There were no significant differences in overall pneumothorax rates between conventional and rapid-rollover groups (19.8% vs. 23.1%, p = 0.164). However, pneumothorax rate requiring drainage catheter placement was significantly lower in rapid-rollover-group (1.6%) than conventional-group (4.2%) (p = 0.010). Multivariate analysis revealed male, age > 60, bulla crossed, fissure crossed, pleura to target distance > 1.3 cm, emphysema along needle tract, and pleural punctures ≥ 2 were significant risk factors of pneumothorax (p < 0.05). Regarding pneumothorax requiring drainage catheter placement, fissure crossed, bulla crossed, and emphysema along needle tract were significant risk factors (p < 0.05), whereas rapid-rollover approach was an independent protective factor (p = 0.002).
  
  
  CONCLUSIONS
  The rapid needle-out patient-rollover approach significantly reduced the rate of pneumothorax requiring drainage catheter placement after CBCT-guided PTNB.
  
  
  CONCLUSIONS
  • The rapid-rollover approach had little beneficial effect on overall pneumothorax rate. • The rapid-rollover approach significantly reduced drainage catheter placement due to pneumothorax. • The strongest risk factor was pleural punctures ≥ 2 per procedure. • Emphysema along the needle tract was a stronger risk factor than fissure-crossed.
authors: Department of Radiology, Seoul National University College of Medicine, 101, Daehangno, Jongno-gu, Seoul, 110-744, South Korea.
authors: Jung Im
authors: JI
authors: Kim
authors: Chang Min
authors: CM
authors: Park
authors: Sang Min
authors: SM
authors: Lee
authors: Jin Mo
authors: JM
authors: Goo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D057785:Catheters; D002648:Child; D054893:Cone-Beam Computed Tomography / Q000379:methods*; D004322:Drainage / Q000295:instrumentation / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011030:Pneumothorax / Q000517:prevention & control* / Q000628:therapy; D015641:Radiography, Interventional / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
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