Jalaeian Hamed, Richardson Kenneth, Kozlowski Konrad, Patel Anmol, Venkat Shree
Department of Interventional Radiology, University of Miami Miller School of Medicine, Miami, FL, USA.
J Thorac Dis. 2024 Jul 30;16(7):4310-4318. doi: 10.21037/jtd-24-240. Epub 2024 Jul 16.
It has been thought a larger bore biopsy needle may yield a better sample for molecular testing, but this could potentially expose the patient to higher pneumothorax rates. This study aims to determine if a larger bore biopsy system results in more complications.
A total of 193 patients who underwent computed tomography (CT)-guided lung biopsy in a single tertiary center from 2013-2021 were evaluated retrospectively. Patients were divided into two groups, patients who underwent lung biopsy using the 17/18-gauge (18G) biopsy system and the 19/20-gauge (20G) biopsy system. Data recorded included biopsy needle gauge, nodule location and size, plug use, positioning, the length of the intraparenchymal tract, number of biopsy passes, pneumothorax, chest tube insertion, and admission.
The mean age was 64.1±12.4 years. The median diameter of the lung nodules was 1.95 cm, and the median depth of the intraparenchymal needle tract was 2.7 cm. Pneumothorax was identified during the procedure by CT fluoroscopy or on post-procedural chest X-ray (CXR). The overall rate of pneumothorax among all patients was 35.2%, and 10.9% of the study population (i.e., 30.1% of patients with pneumothorax) required chest tube insertion. The rate of pneumothorax or chest tube insertion was not significantly different between patients who underwent lung biopsy using 17/18G or 19/20G biopsy system. Patients who developed pneumothorax were older, with smaller-sized pulmonary nodules and longer length of the intraparenchymal tract. The pathologic sensitivity of the 18G gun was higher than that of the 20G gun (93% sensitivity, 100% specificity 79.5% sensitivity, 100% specificity). In the multivariate logistic regression fitted model, the length of the intraparenchymal tract was the only factor predictive of post-procedural pneumothorax and chest tube insertion. An intraparenchymal needle tract length of greater than 2 cm was identified to have the best threshold to predict pneumothorax [sensitivity: 73.5%; false positive rate: 57.6%; area under the curve: 66.27%].
Findings suggest similar rates of pneumothorax and chest tube insertion using small 19/20G 17/18G biopsy systems. The 18G system was more sensitive compared to the 20G system in determining pathologic results. Increasing length of lung parenchyma needle tract and smaller lung nodules appear to be risk factors for pneumothorax. Physicians should plan on intraparenchymal tracts that are less than 2 cm to decrease the chance of pneumothorax.
人们一直认为，较大口径的活检针可能会获得更好的分子检测样本，但这可能会使患者面临更高的气胸发生率。本研究旨在确定较大口径的活检系统是否会导致更多并发症。
回顾性评估了2013年至2021年在单个三级中心接受计算机断层扫描（CT）引导下肺活检的193例患者。患者分为两组，分别是使用17/18号（18G）活检系统和19/20号（20G）活检系统进行肺活检的患者。记录的数据包括活检针规格、结节位置和大小、栓塞使用情况、定位、实质内穿刺道长度、活检穿刺次数、气胸、胸腔闭式引流管置入和住院情况。
平均年龄为64.1±12.4岁。肺结节的中位直径为1.95厘米，实质内穿刺道的中位深度为2.7厘米。在操作过程中通过CT透视或术后胸部X线（CXR）检查发现气胸。所有患者的气胸总发生率为35.2%，研究人群中有10.9%（即气胸患者的30.1%）需要置入胸腔闭式引流管。使用17/18G或19/20G活检系统进行肺活检的患者，气胸或胸腔闭式引流管置入率无显著差异。发生气胸的患者年龄较大，肺结节较小，实质内穿刺道较长。18G活检枪的病理敏感性高于20G活检枪（敏感性93%，特异性100%；敏感性79.5%，特异性100%）。在多因素逻辑回归拟合模型中，实质内穿刺道长度是术后气胸和胸腔闭式引流管置入的唯一预测因素。实质内穿刺道长度大于2厘米被确定为预测气胸的最佳阈值[敏感性：73.5%；假阳性率：57.6%；曲线下面积：66.27%]。
研究结果表明，使用19/20G和17/18G小型活检系统的气胸和胸腔闭式引流管置入率相似。与20G系统相比，18G系统在确定病理结果方面更敏感。肺实质穿刺道长度增加和肺结节较小似乎是气胸的危险因素。医生应计划使实质内穿刺道长度小于2厘米，以降低气胸发生的几率。
