Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tübingen, Germany.
Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tübingen, Germany.
Eur J Radiol. 2019 Jul;116:14-20. doi: 10.1016/j.ejrad.2019.04.010. Epub 2019 Apr 19.
To assess the effect of intraparenchymal blood patching (IBP) as well as tumor- and operator-related risk factors on the rate of pneumothoraxes after percutaneous CT-guided core needle biopsy of the lung.
We performed a retrospective analysis of 868 CT-guided lung biopsies that were conducted at our institution between 2003 and 2018, of which 419 (48%) received an IBP. Outcome variable included the rates of pneumothorax and chest tube placement, as well as lesion size (<3 cm versus ≥3 cm long axis diameter), lesion depth (≤2 cm, >2-4 cm, >4-5 cm and >5 cm distance to the pleura), location within the lungs (upper lobe, lower lobe, middle lobe), needle caliber (13 G, 15 G, 17 G, 19 G), number of samples taken (1-3 versus ≥4 samples), and experience of the performing physician.
The rate of pneumothorax was significantly (p < 0.05) lower in the group with IBP (10.7%) compared to the group without IBP (15.4%). The number of post-interventional chest tube placements was also lower in the IBP group (3.1% vs. 5.8%) but not statistically significant. The lesion size correlated negatively with the rate of pneumothoraxes, whereas in both groups (±IBP) lesions ≥ 3 cm showed a significantly lower rate of pneumothorax (p < 0.05). With increasing lesion depth, the pneumothorax rate increased with (p < 0.01) and without (p < 0.001) IBP. The rate of pneumothorax was significantly lower (p < 0.05) for 17 G needles with IBP, but not for other calibers. For biopsies in the lower lobe, the pneumothorax rate reduced significantly (p < 0.001) with IBP. In case of ≥4 tissue samples, the pneumothorax rate was significantly lower with IBP (p < 0.01). For experienced operators, the overall pneumothorax rate was significantly lower compared to less experienced operators (p < 0001).
IBP significantly reduces the rate of pneumothorax following CT-guided lung biopsies in particular for lesions located deeper in the lungs, when ≥4 samples are taken, when samples are taken by less-experienced operators, and when sampling from the lower lobes.
评估肺内血补丁（IBP）以及肿瘤和操作者相关危险因素对经皮 CT 引导下肺穿刺活检后气胸发生率的影响。
我们对 2003 年至 2018 年在我院进行的 868 例 CT 引导下肺活检进行回顾性分析，其中 419 例（48%）接受了 IBP。结果变量包括气胸和胸腔引流管放置的发生率，以及病变大小（<3cm 与长轴直径≥3cm）、病变深度（≤2cm、>2-4cm、>4-5cm 和>5cm 至胸膜距离）、肺内位置（上叶、下叶、中叶）、针号（13G、15G、17G、19G）、取样数量（1-3 个与≥4 个样本）和操作医生的经验。
接受 IBP 的患者气胸发生率明显低于未接受 IBP 的患者（10.7% vs. 15.4%）（p<0.05）。IBP 组的术后胸腔引流管放置数量也较低（3.1% vs. 5.8%），但无统计学意义。病变大小与气胸发生率呈负相关，而在两组（±IBP）中，≥3cm 的病变气胸发生率显著降低（p<0.05）。随着病变深度的增加，气胸发生率增加（p<0.01）和（p<0.001）无 IBP 时。在接受 IBP 的情况下，17G 针的气胸发生率明显降低（p<0.05），但其他口径的针则没有。对于下叶活检，气胸发生率显著降低（p<0.001）。在进行≥4 个组织样本活检时，接受 IBP 的气胸发生率显著降低（p<0.01）。对于经验丰富的操作者，与经验不足的操作者相比，整体气胸发生率显著降低（p<0.0001）。
IBP 显著降低了 CT 引导下肺活检后气胸的发生率，特别是对于位于肺部较深处的病变、当取样数量≥4 个、由经验不足的操作者取样以及从下叶取样时。
