评估计算机断层扫描引导下肺活检并发症的危险因素：预测气胸的定量分析。
Assessing risk factors for complications in computer tomography-guided lung biopsy: quantitative analysis for predicting pneumothorax.
机构信息
From the Department of Infectious Diseases, First Hospital of Qinhuangdao, Qinhuangdao, Hebei, China.
From the Department of Interventional Treatment, First Hospital of Qinhuangdao, Qinhuangdao, Hebei, China.
出版信息
Ann Saudi Med. 2024 Jul-Aug;44(4):228-233. doi: 10.5144/0256-4947.2024.228. Epub 2024 Aug 1.
BACKGROUND
Computer tomography (CT)-guided lung biopsy carries the risk of pneumothorax. A variety of other risk factors affect the occurrence of pneumothorax.
OBJECTIVE
Assess the incidence and risk factors associated with pneumothorax complications in CT-guided lung biopsy, and to conduct a quantitative analysis of the variables among the significant risk factors to identify more effective indicators for predicting pneumothorax complications.
DESIGN
Retrospective logistic.
SETTING
Single center in China.
PATIENTS AND METHODS
From June 2017 to May 2021, consecutive patients who underwent CT-guided lung biopsy were identified from the medical record system. Binary logistic regression analysis was used to identify potential risk factors for pneumothorax. Receiver operating characteristic (ROC) curves were constructed for continuous variables to determine cutoff values that optimized sensitivity and specificity.
MAIN OUTCOME MEASURES
The incidence and risk factors of pneumothorax in CT-guided lung biopsy.
SAMPLE SIZE
132 patients.
RESULTS
The incidence of pneumothorax was 28.9% (38/132), with 6.8% (9/132) of patients requiring chest tube insertion. Results indicated that smaller lesion size (OR 0.724; 95% CI 0.619-0.848; =.0001), longer needle tract length (OR 1.320; 95% CI 1.145-1.521; =.001), multiple passes through the pleura (OR 4.618; 95% CI 1.378-15.467; =.013), and needle tract length/lesion diameter (L/D) ratio (OR 0.028; 95% CI 0.002-0.732; =.007) were independent risk factors for pneumothorax. ROC curve analysis determined a cut-off value of 0.81 for the L/D ratio (sensitivity=89.5%, specificity=71.3%). The area under the ROC curve (AUC) values of maximum diameter, needle tract length, and L/D ratio for pneumothorax were 0.749, 0.812, and 0.850, respectively.
CONCLUSIONS
The L/D ratio, multiple passes through the pleura, longer needle tract length, and smaller lesions were independent risk factors for pneumothorax. A L/D ratio of less than 0.81 may indicate a pneumothorax. It may be necessary to use the proper sealing procedure for this patient group.
LIMITATIONS
Due to its retrospective nature, there may be inherent selection bias.
背景
计算机断层扫描（CT）引导下的肺活检有发生气胸的风险。许多其他的风险因素也会影响气胸的发生。
目的
评估 CT 引导下肺活检中气胸并发症的发生率和相关风险因素，并对显著风险因素中的变量进行定量分析，以确定预测气胸并发症更有效的指标。
设计
回顾性逻辑。
地点
中国的一个单中心。
患者和方法
从 2017 年 6 月至 2021 年 5 月，从病历系统中确定了接受 CT 引导下肺活检的连续患者。使用二元逻辑回归分析来识别气胸的潜在风险因素。为连续变量构建接收者操作特征（ROC）曲线，以确定优化敏感性和特异性的截断值。
主要观察指标
CT 引导下肺活检中气胸的发生率和风险因素。
样本量
132 例患者。
结果
气胸的发生率为 28.9%（38/132），其中 6.8%（9/132）的患者需要插入胸腔引流管。结果表明，病灶较小（比值比 0.724；95%置信区间 0.619-0.848；=.0001）、针道较长（比值比 1.320；95%置信区间 1.145-1.521；=.001）、多次穿过胸膜（比值比 4.618；95%置信区间 1.378-15.467；=.013）和针道长度/病灶直径（L/D）比值（比值比 0.028；95%置信区间 0.002-0.732；=.007）是气胸的独立危险因素。ROC 曲线分析确定 L/D 比值的截断值为 0.81（敏感性=89.5%，特异性=71.3%）。ROC 曲线下面积（AUC）值分别为最大直径、针道长度和 L/D 比值的 0.749、0.812 和 0.850。
结论
L/D 比值、多次穿过胸膜、较长的针道长度和较小的病灶是气胸的独立危险因素。L/D 比值小于 0.81 可能提示气胸。对于这组患者，可能需要使用适当的密封程序。
局限性
由于其回顾性，可能存在固有选择偏倚。
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