Department of Diagnostic and Interventional Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany.
Sci Rep. 2020 Jul 3;10(1):10978. doi: 10.1038/s41598-020-67348-0.
The aim of this study was to evaluate the risk of pneumothorax and need for chest tube insertion in CT-guided lung biopsies and identify predictors focusing on pulmonary emphysema determined with quantitative computed tomography. To that end, we retrospectively analysed the incidence of pneumothorax and chest tube insertion in 371 CT-guided lung biopsies with respect to the quantitative emphysema score determined with the density mask technique. Other possible impact factors considered were lesion diameter, length of biopsy pathway within the lung parenchyma, lung lobe, needle size, puncture technique, patient positioning and interventionalist's level of experience. Quantitative emphysema scores of the lung were significantly higher in patients who developed instant pneumothorax (27%, p < 0.0001), overall pneumothorax (38%, p = 0.001) and had chest tube insertion (9%, p = 0.006) compared to those who did not when analysed with the Mann-Whitney U-test. In logistic regression analysis with inclusion of the other possible impact factors, the quantitative emphysema score remained a statistically significant predictor for all three output parameters. This was confirmed with least absolute shrinkage and selection operator (Lasso) regression analysis. In conclusion, quantitatively determined pulmonary emphysema is a positive predictor of the pneumothorax rate in CT-guided lung biopsy and likelihood of chest tube insertion.
本研究旨在评估 CT 引导下肺活检中气胸的风险和需要插入胸腔引流管的情况，并确定与定量 CT 确定的肺气肿有关的预测因素。为此，我们回顾性分析了 371 例 CT 引导下肺活检中气胸和胸腔引流管插入的发生率，这些活检与密度掩模技术确定的定量肺气肿评分有关。考虑的其他可能影响因素包括病变直径、肺实质内活检路径的长度、肺叶、针的大小、穿刺技术、患者体位和介入医生的经验水平。在 Mann-Whitney U 检验中，与未发生气胸的患者相比，发生即时气胸（27%，p<0.0001）、总体气胸（38%，p=0.001）和需要插入胸腔引流管的患者（9%，p=0.006）的肺定量肺气肿评分显著更高。在包含其他可能影响因素的逻辑回归分析中，定量肺气肿评分仍然是所有三个输出参数的统计学显著预测因子。最小绝对收缩和选择算子（Lasso）回归分析也证实了这一点。总之，定量确定的肺气肿是 CT 引导下肺活检中气胸发生率和需要插入胸腔引流管的可能性的阳性预测因子。
