Hu Huan, Li Chuling, Lv Tangfeng, Li Huijuan, Hu Yangbo, Shen Qin, Mino-Kenudson Mari, Bertolaccini Luca, Rocco Gaetano, Zarogoulidis Pavlos, Zhang Fang, Lin Dang, Liu Hongbing, Song Yong
Department of Respiratory Medicine, Suzhou Hospital Affiliated Nanjing Medical University, Suzhou, China.
Department of Respiratory Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, China.
Ann Transl Med. 2021 Feb;9(4):288. doi: 10.21037/atm-20-4384.
Hemorrhage is the second most common complication of percutaneous transthoracic needle biopsy (PTNB), and at present, there is no effective prevention strategy. Contrast-enhanced computed tomography (CECT) has the advantage of clearly visualizing blood supply within the lesion and aiding in the imaging of blood vessels, which can reduce hemorrhage complicating PTNB. As no large-sample studies were evaluating whether CECT could reduce hemorrhage, we conducted the present retrospective study.
From November 2011 to February 2016, 1,282 biopsies at Jinling Hospital were retrospectively reviewed; 555 underwent CECT, and 727 underwent non-contrast computed tomography (CT). Factors associated with hemorrhage were defined, and hemorrhage rates were compared between the 2 groups.
We found that pre-biopsy CECT was associated with a reduced incidence of biopsy-related hemorrhage compared to non-contrast CT (16.4% 23.1%, P=0.003). Propensity score matching (PSM) analysis also showed that the incidence of hemorrhage in the CECT group was lower than that of the non-contrast CT group at a ratio of 1:1 (P=0.039), 1:2 (P=0.028), or 1:3 (P=0.013). In the multivariate analysis, CECT before PTNB was found to be significantly associated with a reduced risk of hemorrhage [odds ratio (OR): 0.671, 95% confidence interval (CI): 0.499-0.902, P=0.008]. Puncture position, lesion size, depth of needle tract, and the number of punctures were also found to be associated with hemorrhage (all P<0.05).
Compared with non-contrast CT, CECT significantly reduced the risk of post-biopsy pulmonary hemorrhage, which suggests that CECT should be performed before PTNB.
出血是经皮经胸针吸活检术（PTNB）的第二常见并发症，目前尚无有效的预防策略。对比增强计算机断层扫描（CECT）具有能清晰显示病变内血供并有助于血管成像的优势，可减少PTNB的出血并发症。由于尚无大样本研究评估CECT是否能减少出血，我们开展了本回顾性研究。
回顾性分析2011年11月至2016年2月在金陵医院进行的1282例活检；555例行CECT，727例行非增强计算机断层扫描（CT）。确定与出血相关的因素，并比较两组的出血率。
我们发现，与非增强CT相比，活检前CECT与活检相关出血的发生率降低有关（16.4%对23.1%，P = 0.003）。倾向评分匹配（PSM）分析还显示，CECT组的出血发生率低于非增强CT组，比例为1:1（P = 0.039）、1:2（P = 0.028）或1:3（P = 0.013）。在多变量分析中，发现PTNB前的CECT与出血风险降低显著相关[比值比（OR）：0.671，95%置信区间（CI）：0.499 - 0.902，P = 0.008]。穿刺位置、病变大小、针道深度和穿刺次数也与出血有关（均P < 0.05）。
与非增强CT相比，CECT显著降低了活检后肺出血的风险，这表明应在PTNB前进行CECT。
