title: Complications in CT-Guided, Semi-Automatic Coaxial Core Biopsy of Potentially Malignant Pulmonary Lesions.
abstract: OBJECTIVE
  Histological verification of pulmonary lesions is important to ensure correct treatment. Computed tomographic (CT) transthoracic core biopsy is a well-established procedure for this. Comparison of available studies is difficult though, as technical and patient characteristics vary. Using a standardized biopsy technique, we evaluated our results for CT-guided coaxial core biopsy in a semi-automatic technique.
  
  
  METHODS
  Within 2 years, 664 consecutive transpulmonary biopsies were analyzed retrospectively. All interventions were performed using a 17/18G semi-automatic core biopsy system (4 to 8 specimens). The incidence of complications and technical and patient-dependent risk factors were evaluated.
  
  
  RESULTS
  Comparing the histology with the final diagnosis, the sensitivity was 96.3%, and the specificity was 100%. 24 procedures were not diagnostic. In all others immunohistological staining was possible. The main complication was pneumothorax (PT, 21.7%), with chest tube insertion in 6% of the procedures (n = 40). Bleeding without therapeutic consequences was seen in 43 patients. There was no patient mortality. The rate of PT with chest tube insertion was 9.6% in emphysema patients and 2.8% without emphysema (p = 0.001). Smokers with emphysema had a 5 times higher risk of developing PT (p = 0.001). Correlation of tumor size or biopsy angle and the risk of PT was not significant. The risk of developing a PT was associated with an increasing intrapulmonary depth of the lesion (p = 0.001).
  
  
  CONCLUSIONS
  CT-guided, semiautomatic coaxial core biopsy of the lung is a safe diagnostic procedure. The rate of major complications is low, and the sensitivity and specificity of the procedure are high. Smokers with emphysema are at a significantly higher risk of developing pneumothorax and should be monitored accordingly.
  
  
  CONCLUSIONS
  Using an 18G core biopsy system with 6 specimens will allow immunohistological staining with high sensitivity and specificity. Smokers with emphysema are at a significantly higher risk of developing a pneumothorax.
authors.affiliation: Department of Radiology, Klinik Löwenstein, Löwenstein, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Schulze
authors.affiliation: Department of Thoracic and Vascular Surgery, Klinik Löwenstein, Löwenstein, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Seebacher
authors.affiliation: Department of Thoracic and Vascular Surgery, Klinik Löwenstein, Löwenstein, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Enderes
authors.affiliation: Department of Thoracic and Vascular Surgery, Klinik Löwenstein, Löwenstein, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Kugler
authors.affiliation: Department of Oncology, Klinik Löwenstein, Löwenstein, Germany.
authors.forename: J R
authors.initials: JR
authors.lastname: Fischer
authors.affiliation: Department of Thoracic and Vascular Surgery, Klinik Löwenstein, Löwenstein, Germany.
authors.forename: T P
authors.initials: TP
authors.lastname: Graeter
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D062005:Biopsy, Large-Core Needle / Q000009:adverse effects* / Q000295:instrumentation* / Q000379:methods; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D061705:Image-Guided Biopsy / Q000009:adverse effects* / Q000295:instrumentation* / Q000379:methods; D008168:Lung / Q000473:pathology; D008175:Lung Neoplasms / Q000473:pathology* / Q000556:secondary; D008297:Male; D008875:Middle Aged; D011030:Pneumothorax / Q000209:etiology / Q000628:therapy; D011237:Predictive Value of Tests; D014057:Tomography, X-Ray Computed / Q000009:adverse effects* / Q000295:instrumentation*; D055815:Young Adult