Peng Bo, Deng Zhenglong, Wang Yuxi, Xu Shuhao, Luo Dong, Du Zedong, Liu Le, Hu Ying, Ren Yi
Department of Interventional Radiology, Chengdu Second People's Hospital, Chengdu, China.
Quant Imaging Med Surg. 2023 Feb 1;13(2):707-719. doi: 10.21037/qims-22-474. Epub 2022 Dec 5.
Pneumothorax is the most frequent complication in computed tomography-guided lung needle biopsy (CT-LNB) and generally appears immediately or within an hour after CT-LNB. Preventing pneumothorax after CT-LNB requires a preoperative evaluation of risk factors. This study investigated risk factors for the occurrence of immediate pneumothorax after CT-LNB.
A total of 311 CT-LNB procedures were conducted for 290 patients (217 males and 73 females) with persistent solid or part-solid pulmonary lesions in this case-control study. We retrospectively evaluated immediate postbiopsy pneumothorax complications and associated risk factors. The possible risk factors for immediate pneumothorax were analyzed, including 12 parameters in demographics, radiological features, and procedural factors. Univariate and multivariate logistic regression analyses were used to investigate independent risk factors for the occurrence of immediate pneumothorax after CT-LNB.
All CT-LNB procedures (100%) were technically successful. Immediate pneumothorax after CT-LNB occurred in 115 out of the 311 procedures (36.9%). Chest tube placement was required for 12.2% (14/115) of the pneumothoraces (14/311, 4.5% of the total number of CT-LNB procedures). The other pneumothoraces were treated conservatively. Independent risk factors of immediate pneumothorax included a lesion with pleural tail sign [PTS; odds ratio (OR) =3.021, 95% confidence interval (CI): 1.703-5.359; P<0.001], smaller lesion size (OR =0.827, 95% CI: 0.705-0.969; P=0.019), a lesion in the middle or lower lobe (OR =2.237, 95% CI: 1.267-3.951; P=0.006), a higher number of pleural punctures (OR =2.710, 95% CI: 1.399-5.248; P=0.003), and a deep-seated lesion (OR =1.622, 95% CI: 1.261-2.088; P<0.001).
PTS is a novel risk factor for immediate pneumothorax and may increase the immediate pneumothorax rate after CT-LNB. Practitioners should be vigilant of the risk of immediate pneumothorax after CT-LNB in lung lesions with PTS.
气胸是计算机断层扫描引导下肺穿刺活检（CT-LNB）最常见的并发症，通常在CT-LNB后立即或1小时内出现。预防CT-LNB后的气胸需要对危险因素进行术前评估。本研究调查了CT-LNB后立即发生气胸的危险因素。
在这项病例对照研究中，对290例（217例男性和73例女性）患有持续性实性或部分实性肺部病变的患者进行了总共311次CT-LNB操作。我们回顾性评估了活检后立即出现的气胸并发症及相关危险因素。分析了立即发生气胸的可能危险因素，包括人口统计学、放射学特征和操作因素中的12个参数。采用单因素和多因素逻辑回归分析来研究CT-LNB后立即发生气胸的独立危险因素。
所有CT-LNB操作（100%）技术上均成功。311次操作中有115次（36.9%）在CT-LNB后立即发生气胸。12.2%（14/115）的气胸患者需要放置胸腔引流管（14/311，占CT-LNB操作总数的4.5%）。其他气胸采用保守治疗。立即发生气胸的独立危险因素包括有胸膜尾征[PTS]的病变[比值比（OR）=3.021，95%置信区间（CI）：1.703 - 5.359；P<0.001]、病变较小（OR =0.827，95%CI：0.705 - 0.969；P =0.019）、病变位于中叶或下叶（OR =2.237，95%CI：1.267 - 3.951；P =0.006）、胸膜穿刺次数较多（OR =2.710，95%CI：1.399 - 5.248；P =0.003）以及病变位置较深（OR =1.622，95%CI：1.261 - 2.088；P<0.001）。
PTS是立即发生气胸的一个新的危险因素，可能会增加CT-LNB后立即发生气胸的几率。从业者应警惕在有PTS的肺部病变进行CT-LNB后立即发生气胸的风险。
