Department of Radiology, Seoul National University College of Medicine, and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul 03080, Korea.
Cancer Research Institute, Seoul National University, Seoul 03080, Korea.
Korean J Radiol. 2018 Sep-Oct;19(5):880-887. doi: 10.3348/kjr.2018.19.5.880. Epub 2018 Aug 6.
We hypothesized that open bronchi within target pulmonary lesions are associated with percutaneous transthoracic needle biopsy (PTNB)-related hemoptysis. We sought to analyze and compare patient characteristics and target features as well as biopsy-related factors between patients with and without PTNB-related hemoptysis.
We retrospectively analyzed 1484 patients (870 males and 614 females; median age, 66 years) who had undergone 1569 cone-beam CT (CBCT)-guided PTNBs. Patient characteristics (sex, age, and pathologic diagnosis), nodule features (nodule type, size, location, and presence of an open bronchus in target nodules), and biopsy-related factors (biopsy needle size, pleura-to-target distance, blood test results, open bronchus unavoidability [OBU] index, etc.) were investigated. OBU index, which was assessed using the pre-procedural CBCT, was a subjective scoring system for the probability of needle penetration into the open bronchus. Univariate analysis and subsequent multivariate logistic regression analysis were conducted to reveal the independent risk factors for PTNB-related hemoptysis. For a subgroup of nodules with open bronchi, a trend analysis between the occurrence of hemoptysis and the OBU index was performed.
The independent risk factors for hemoptysis were sex (female; odds ratio [OR], 1.918; < 0.001), nodule size (OR, 0.837; < 0.001), open bronchus (OR, 2.101; < 0.001), and pleura-to-target distance (OR, 1.135; = 0.003). For the target nodules with open bronchi, a significant trend between hemoptysis and OBU index ( < 0.001) was observed.
An open bronchus in a biopsy target is an independent predictor of hemoptysis, and careful imaging review may potentially reduce PTNB-related hemoptysis.
我们假设目标肺部病变内的开放支气管与经皮经胸针吸活检（PTNB）相关的咯血有关。我们旨在分析和比较有和无 PTNB 相关咯血的患者的特征和目标特征以及活检相关因素。
我们回顾性分析了 1484 名接受了 1569 次锥形束 CT（CBCT）引导下 PTNB 的患者（870 名男性和 614 名女性；中位年龄为 66 岁）。研究了患者特征（性别、年龄和病理诊断）、结节特征（结节类型、大小、位置和目标结节中开放支气管的存在）以及活检相关因素（活检针大小、胸膜至目标距离、血液检查结果、开放支气管不可避免性（OBU）指数等）。OBU 指数是使用术前 CBCT 评估的，是一个用于评估针穿透开放支气管可能性的主观评分系统。进行了单因素分析和随后的多变量逻辑回归分析，以揭示 PTNB 相关咯血的独立危险因素。对于有开放支气管的结节亚组，进行了咯血发生与 OBU 指数之间的趋势分析。
咯血的独立危险因素为性别（女性；优势比[OR]，1.918； < 0.001）、结节大小（OR，0.837； < 0.001）、开放支气管（OR，2.101； < 0.001）和胸膜至目标距离（OR，1.135； = 0.003）。对于有开放支气管的目标结节，观察到咯血与 OBU 指数之间存在显著的趋势（ < 0.001）。
活检目标中的开放支气管是咯血的独立预测因子，仔细的影像学审查可能会降低 PTNB 相关咯血的风险。
