Department of Radiology, Montefiore Medical Center, 111 East 210th Street, Bronx, NY, 10467, USA.
Department of Radiology, NYU Langone Tisch Hospital, 560 First Avenue, 2nd Floor, New York, NY, 10016, USA.
Lung. 2021 Jun;199(3):299-305. doi: 10.1007/s00408-021-00445-7. Epub 2021 Apr 19.
To assess the risk factors, incidence and significance of pneumothorax in patients undergoing CT-guided lung biopsy.
Patients who underwent a CT-guided lung biopsy between August 10, 2010 and September 19, 2016 were retrospectively identified. Imaging was assessed for immediate and delayed pneumothorax. Records were reviewed for presence of risk factors and the frequency of complications requiring chest tube placement. 604 patients were identified. Patients who underwent chest wall biopsy (39) or had incomplete data (9) were excluded.
Of 556 patients (average age 66 years, 50.2% women) 26.3% (146/556) had an immediate pneumothorax and 2.7% (15/556) required chest tube placement. 297/410 patients without pneumothorax had a delayed chest X-ray. Pneumothorax developed in 1% (3/297); one patient required chest tube placement. Pneumothorax risk was associated with smaller lesion sizes (OR 0.998; 95% CI (0.997, 0.999); [p = 0.002]) and longer intrapulmonary needle traversal (OR 1.055; 95% CI (1.033, 1.077); [p < 0.001]). Previous ipsilateral lung surgery (OR 0.12; 95% CI (0.031, 0.468); [p = 0.002]) and longer needle traversal through subcutaneous tissue (OR 0.976; 95% CI (0.96, 0.992); [p = 0.0034]) were protective of pneumothorax. History of lung cancer, biopsy technique, and smoking history were not significantly associated with pneumothorax risk.
Delayed pneumothorax after CT-guided lung biopsy is rare, developing in 1% of our cohort. Pneumothorax is associated with smaller lesion size and longer intrapulmonary needle traversal. Previous ipsilateral lung surgery and longer needle traversal through subcutaneous tissues are protective of pneumothorax. Stratifying patients based on pneumothorax risk may safely obviate standard post-biopsy delayed chest radiographs.
评估 CT 引导下肺活检患者发生气胸的风险因素、发生率和意义。
回顾性分析 2010 年 8 月 10 日至 2016 年 9 月 19 日期间进行 CT 引导下肺活检的患者。对即刻和迟发性气胸的影像学表现进行评估。记录患者的风险因素及是否需要放置胸腔引流管的并发症发生情况。共纳入 604 例患者，排除行胸壁活检的患者（39 例）和资料不全的患者（9 例）。
556 例患者（平均年龄 66 岁，50.2%为女性）中，26.3%（146/556）患者发生即刻气胸，2.7%（15/556）需要放置胸腔引流管。410 例无气胸的患者中有 297 例进行了延迟性胸部 X 线检查。气胸发生率为 1%（3/297），1 例患者需要放置胸腔引流管。气胸风险与病灶较小（比值比 0.998；95%置信区间为 0.997～0.999；p=0.002）和肺内进针距离较长（比值比 1.055；95%置信区间为 1.033～1.077；p<0.001）相关。同侧肺部手术史（比值比 0.12；95%置信区间为 0.031～0.468；p=0.002）和更长的针穿过皮下组织（比值比 0.976；95%置信区间为 0.96～0.992；p=0.0034）可降低气胸风险。肺癌病史、活检技术和吸烟史与气胸风险无显著相关性。
CT 引导下肺活检后迟发性气胸罕见，本研究队列发生率为 1%。气胸与病灶较小和肺内进针距离较长有关。同侧肺部手术史和更长的针穿过皮下组织可降低气胸风险。根据气胸风险对患者进行分层可安全避免标准的活检后延迟性胸部 X 线检查。
