From the Department of Interventional Radiology, Institut Gustave Roussy, Villejuif, Île-de France, France.
Radiology. 2022 Feb;302(2):473-480. doi: 10.1148/radiol.2021210360. Epub 2021 Nov 2.
Background Percutaneous CT-guided biopsy of lung nodules is an established method with high diagnostic accuracy but a high rate of pneumothorax and chest tube insertion compared with endobronchial methods. Purpose To investigate the effect of a protocol combining patient positioning biopsy-side down, needle removal during expiration, autologous blood patch sealing, rapid rollover, and pleural patching (PEARL) on complication rate after percutaneous CT-guided lung biopsy, especially chest tube insertion. Materials and Methods In a secondary analysis of both prospectively and retrospectively acquired data from December 2019 to November 2020, consecutive participants underwent biopsy with use of the PEARL protocol (prospective data) and were compared with patients who underwent biopsy at the same tertiary cancer center according to the standard method without any additional techniques (controls, retrospective data). Patient demographics, lesion characteristics, intraprocedural data, complications, and histologic results were recorded and compared. Results One hundred patients in the control group (mean age ± standard deviation, 63 years ± 12; 61 men) and 100 participants in the PEARL group (mean age, 64 years ± 12; 48 men) were evaluated. No differences were found in patient and lesion characteristics. The emphysema rate was 47 of 100 patients (47%) in both groups. The rate of pneumothorax was 37 of 100 patients (37%) in the control group versus 16 of 100 (16%) in the PEARL group ( = .001). Of the pneumothoraxes that occurred, fewer were during the intervention in the PEARL group, with 21 of 37 onsets (57%) in the control group versus three of 16 onsets (19%) in the PEARL group ( < .001). A chest tube was inserted in 13 of 100 patients (13%) in the control group and only in one of 100 (1%) in the PEARL group ( = .002). Histologic findings were diagnostic in 94 of 100 patients (94%) in the control group and 95 of 100 (95%) in the PEARL group ( > .99). Conclusion During CT-guided percutaneous lung biopsy, a protocol of positioning biopsy-side down, needle removal during expiration, autologous blood patch sealing, rapid rollover, and pleural patching, or PEARL, reduced rates of pneumothorax and chest tube insertion. © RSNA, 2021.
与支气管内方法相比，经皮 CT 引导下肺结节活检是一种具有较高诊断准确性的成熟方法，但气胸和胸腔管插入的发生率较高。目的：研究一种方案对经皮 CT 引导下肺活检后并发症发生率的影响，特别是胸腔管插入率，该方案结合了患者体位活检侧向下、呼气时拔出针、自体血补丁密封、快速翻转和胸膜贴补（PEARL）。材料与方法：在 2019 年 12 月至 2020 年 11 月期间前瞻性和回顾性采集的数据的二次分析中，连续患者接受了使用 PEARL 方案（前瞻性数据）的活检，并与在同一三级癌症中心按照标准方法（无任何附加技术）进行活检的患者（对照组，回顾性数据）进行了比较。记录并比较了患者人口统计学特征、病变特征、术中数据、并发症和组织学结果。结果：对照组 100 例患者（平均年龄±标准差，63 岁±12；61 例男性）和 PEARL 组 100 例患者（平均年龄，64 岁±12；48 例男性）进行了评估。两组患者和病变特征无差异。100 例患者中有 47 例（47%）患有肺气肿，两组均为 47 例。对照组中气胸发生率为 100 例患者中有 37 例（37%），PEARL 组为 100 例患者中有 16 例（16%）（ =.001）。发生的气胸中，PEARL 组术中发生的气胸较少，对照组 37 例中有 21 例（57%），PEARL 组 16 例中有 3 例（19%）（ <.001）。对照组 100 例患者中有 13 例（13%）需要插入胸腔管，而 PEARL 组仅 1 例（1%）需要插入胸腔管（ =.002）。对照组 100 例患者中有 94 例（94%）的组织学发现具有诊断意义，PEARL 组中有 100 例患者中有 95 例（95%）（>.99）。结论：在 CT 引导下经皮肺活检中，一种体位活检侧向下、呼气时拔出针、自体血补丁密封、快速翻转和胸膜贴补或 PEARL 的方案可降低气胸和胸腔管插入的发生率。
