Department of Imaging, University Hospital of Liège, Liège, Belgium.
Department of Biostatistics, University of Liège, Liège, Belgium.
J Vasc Interv Radiol. 2024 Nov;35(11):1687-1694. doi: 10.1016/j.jvir.2024.07.019. Epub 2024 Jul 27.
To compare the effectiveness of 2 track sealing techniques following computed tomography (CT)-guided lung biopsy using either gelatin sponge slurry (GSS) or saline to reduce the rate of postbiopsy pneumothorax.
In this prospective study, a total of 266 patients (median age, 66.2 years; range, 25.5-89.2 years; 150 men) were included between July 2019 and January 2023. The patients referred for a CT-guided lung biopsy, in whom the needle would pass through aerated lung, were randomly assigned to either the GSS sealing technique group (n = 132) or the saline track sealing technique (n = 134) in a 1:1 ratio. All biopsies were performed using a 19-gauge coaxial needle in a tertiary hospital by 1 of 4 interventional radiologists with varying levels of experience (F.C., L.G., P.L., C.V.). The outcomes were pneumothorax occurrence, pneumothorax-related intervention (simple aspiration and/or drainage), and biopsy-related hospital stay length.
Pneumothorax rates were 12.1% in the GSS group and 24.6% in the saline group (P = .008). Hospital length of stay was significantly shorter in the GSS group (P = .003). The need for pneumothorax-related intervention did not reach statistical significance between the groups (6.8% vs 12.7%; P = .107). In the multiple logistic regression analysis, track sealing with GSS was a protective factor for pneumothorax (odds ratio [OR], 0.44; 95% CI, 0.22-0.87; P = .019), and emphysema was associated with higher risk of pneumothorax (OR, 2.67; 95% CI, 1.31-5.44; P = .007).
Track sealing with GSS following a CT-guided lung biopsy is significantly more effective than saline in reducing postbiopsy pneumothorax and results in shorter hospital stay.
比较 CT 引导下肺活检后使用明胶海绵浆（GSS）或生理盐水进行 2 种轨道密封技术，以降低活检后气胸的发生率。
在这项前瞻性研究中，共纳入 2019 年 7 月至 2023 年 1 月期间因 CT 引导下肺活检而转诊的 266 名患者（中位年龄 66.2 岁；范围 25.5-89.2 岁；150 名男性）。将需要穿过充气肺的针随机分配至 GSS 密封技术组（n=132）或生理盐水轨道密封技术组（n=134），两组比例为 1:1。所有活检均由 4 名介入放射科医生（F.C.、L.G.、P.L.和 C.V.）在一家三级医院使用 19 号同轴针进行，他们的经验水平各不相同。主要结局是气胸的发生、气胸相关干预（单纯抽吸和/或引流）以及活检相关的住院时间长度。
GSS 组气胸发生率为 12.1%，生理盐水组气胸发生率为 24.6%（P=0.008）。GSS 组的住院时间明显更短（P=0.003）。两组气胸相关干预的需求未达到统计学意义（6.8% vs 12.7%；P=0.107）。在多因素逻辑回归分析中，GSS 轨道密封是气胸的保护因素（比值比 [OR]，0.44；95%置信区间 [CI]，0.22-0.87；P=0.019），肺气肿与气胸风险增加相关（OR，2.67；95% CI，1.31-5.44；P=0.007）。
与生理盐水相比，CT 引导下肺活检后 GSS 轨道密封在降低活检后气胸方面更为有效，且可缩短住院时间。
