[The factor analysis of the incidence of complication in CT-guided lung automated cutting needle biopsy with extrapleural locating method].

OBJECTIVE

To evaluate the complication rate and analyze its impact of multiple facts of CT-guided percutaneous lung automated cutting needle biopsies (ACNB) with extrapleural locating method (EPL).

METHODS

Retrospective study where information was obtained from the department of medical imaging, the sign of complication after 480 cases CT-guided ACNB with EPL was observed and its relationship with multiple factors were analyzed by multiple logistic regression model.

RESULTS

The diagnostic accuracy was made in 456 cases (95.0%). The length of the biopsy procedures was 16 ± 2 min and the time of the biopsy needle in pulmonary parenchyma was < 20 s. Seventy-one (14.8%) cases presented pneumothorax which include 7 (1.5%) cases later pneumothorax, and 2 (0.4%) required chest tube insertions. The multivariate logistic regression analysis showed that emphysema, depth of intrapulmonal biopsy path and lesion size were sole effective factors of pneumothorax (OR = 7.991, 1.083, and 0.945 respectively). Lesions with emphysema, depth of intrapulmonal biopsy path and lesion size ≤ 10 mm had higher pneumothorax rates. Eight-seven (18.1%) cases presented pulmonary hemorrhage and twenty-six (5.4%) presented hemoptysis. The multivariate logistic regression analysis showed that depth of intrapulmonal biopsy path, emphysema, and number of pleural needle passes were sole effective factors (OR = 1.143, 0.712, and 0.521, respectively) of pulmonary hemorrhage. In patients with depth > 10 mm or 20 mm, emphysema and number of pleural needle passes had higher hemorrhage rates. The multivariate logistic regression analysis showed that depth of intrapulmonal biopsy path and emphysema were sole effective factors (OR = 1.077, and 0.578, respectively) of hemoptysis. Lesions with depth > 20 mm had higher hemoptysis rate. One case with pulmonary Cryptococcus presented pleural reaction, and three cases had the insistent pain. The total number of severe complications was 15 (3.1%) cases.

CONCLUSION

ACNB with EPL was an accurate method for diagnosing pulmonary lesions. ACNB can be safely performed, which reduces the rate of pneumothorax and hemorrhage. Pneumothorax rate was influenced by emphysema, depth of intrapulmonal biopsy path and lesion size ≤ 10 mm. Hemorrhage was related with depth >10 mm or 20 mm, emphysema and number of pleural needle passes. Hemoptysis was related with depth of intrapulmonal biopsy path >20 mm. Later and severe complications should be considered in procedure.