Tract embolization with gelatin sponge slurry for prevention of pneumothorax after percutaneous computed tomography-guided lung biopsy.

PURPOSE

To determine the effect of embolization with absorbable gelatin sponge slurry on the incidence of pneumothorax (PTX) and need for chest tube placement after percutaneous lung biopsy.

MATERIALS AND METHODS

Seven hundred fifty-two percutaneous lung biopsy procedures and fiducial seed placements were performed using computed tomography (CT)-guidance at a single institution. A retrospective review was performed including 145 patients with embolization (19.28%) of the tract with gelatin sponge slurry during needle withdrawal and 607 patients who did not undergo tract embolization. Patient- and lesion-related characteristics were collected through the electronic health record and PACS. Outcome measures included the occurrence of PTX during or after the biopsy procedure and the need for chest tube placement. Analysis was performed by multivariate logistic regression.

RESULTS

Although tract embolization did not significantly decrease the chances of developing PTX (p = 0.06), it did decrease the likelihood of progressing to requiring chest tube insertion. Without tract embolization, 10.7% of cases required a chest tube, whereas only 6.9% of the patients whose tract was embolized needed a chest tube (p = 0.01). A history of emphysema was associated with 151% increased odds of PTX requiring chest tube placement after lung biopsy (p = 0.009). Tract length >24 mm was associated with a 262% increase in the odds of requiring chest tube placement (p = 0.003).

CONCLUSION

Embolization of the needle tract during percutaneous lung biopsy with gelfoam slurry significantly decreased the odds of requiring a chest tube for PTX and should be considered for all patients, particularly those with emphysema and deep lesions.