Brönnimann Michael P, Manser Leonie, Christe Andreas, Heverhagen Johannes T, Gebauer Bernhard, Auer Timo A, Schnapauff Dirk, Collettini Federico, Schroeder Christophe, Dorn Patrick, Gassenmaier Tobias, Ebner Lukas, Huber Adrian T
Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Rosenbühlgasse 27, 3010 Bern, Switzerland.
Department of Radiology, Charité-Universitätsmedizin Augustenburger Platz 1, 13353 Berlin, Germany.
Tomography. 2025 Mar 14;11(3):35. doi: 10.3390/tomography11030035.
BACKGROUND/OBJECTIVES: The risk of hemorrhage during CT-guided lung biopsy has not been systematically studied in cases where ground-glass opacities (GGO) are present in the access route or when biopsies are performed in highly perfused, dependent lung areas. While patient positioning has been studied for pneumothorax prevention, its role in minimizing hemorrhage risk remains unexplored. This study aimed to determine whether GGOs in the access route and biopsies in dependent lung areas are risk factors for pulmonary hemorrhage during CT-guided lung biopsy.
A retrospective analysis was conducted on 115 CT-guided lung biopsies performed at a single center (2020-2023). Patients were categorized based on post-interventional hemorrhage exceeding 2 cm (Grade 2 or higher). We evaluated the presence of GGOs in the access route and biopsy location (dependent vs. non-dependent areas) using chi square, Fisher's exact, and Mann-Whitney U tests. Univariate and multivariate logistic regression analyses were conducted to evaluate risk factors for pulmonary hemorrhage.
Pulmonary hemorrhage beyond 2 cm occurred in 30 of 115 patients (26%). GGOs in the access route were identified in 67% of these cases ( < 0.01), and hemorrhage occurred more frequently when biopsies were performed in dependent lung areas (63% vs. 40%, = 0.03). Multivariable analysis showed that GGOs in the access route (OR 5.169, 95% CI 1.889-14.144, = 0.001) and biopsies in dependent areas (OR 4.064, 95% CI 1.477-11.186, < 0.001) independently increased hemorrhage risk.
GGOs in the access route and dependent lung area biopsies are independent risk factors for hemorrhage during CT-guided lung biopsy.
背景/目的：在CT引导下肺活检过程中，当穿刺路径存在磨玻璃影（GGO）或在肺灌注良好的下垂部位进行活检时，出血风险尚未得到系统研究。虽然已经研究了患者体位以预防气胸，但其在降低出血风险方面的作用仍未得到探索。本研究旨在确定穿刺路径中的GGO和下垂肺区活检是否为CT引导下肺活检时肺出血的危险因素。
对在单一中心进行的115例CT引导下肺活检（2020 - 2023年）进行回顾性分析。根据介入后出血超过2 cm（2级或更高）对患者进行分类。我们使用卡方检验、Fisher精确检验和Mann-Whitney U检验评估穿刺路径和活检部位（下垂部位与非下垂部位）是否存在GGO。进行单因素和多因素逻辑回归分析以评估肺出血的危险因素。
115例患者中有30例（26%）发生了超过2 cm的肺出血。这些病例中有67%在穿刺路径中发现了GGO（<0.01），并且在下垂肺区进行活检时出血更频繁（63%对40%，=0.03）。多变量分析显示，穿刺路径中的GGO（OR 5.169，95%CI 1.889 - 14.144，=0.001）和下垂部位活检（OR 4.064，95%CI 1.477 - 11.186，<0.001）独立增加出血风险。
穿刺路径中的GGO和下垂肺区活检是CT引导下肺活检时出血的独立危险因素。
