CT-Guided Lung Biopsy with Needle Embolization Using Gelatin Sponge Slurry to Prevent Pneumothorax and Pulmonary Hemorrhage: A Propensity Score Matching Controlled Study.

RATIONALE AND OBJECTIVE

To investigate whether using gelatin sponge slurry to seal the needle tract during computed tomography (CT)-guided lung biopsy can reduce the incidence of pneumothorax (PTX) and pulmonary hemorrhage (PH).

MATERIALS AND METHODS

This retrospective, large-sample, controlled study was conducted in the Interventional Therapy Department of Medical University Cancer Institute and Hospital from December 2022 to January 2023. A total of 1126 patients were included. There were 844 patients in the non-gelatin sponge slurry group (Group A) and 282 patients in the gelatin sponge slurry group (Group B). Group B patients were preoperatively considered to be at higher risk for PTX and/or PH. CT-guided biopsies were performed using a coaxial technique, injecting 1-3 ml of gelatin sponge slurry while withdrawing the needle. Chi-square tests compared the PTX rate, PH rate, chest tube placement rate, and significant pulmonary hemorrhage rate between Group A and Group B. Univariate and multivariate logistic regression analyses identified risk factors for PTX and PH in the entire cohort and within each group. Factors included demographics, lesion characteristics, and biopsy technical parameters. Propensity Score Matching (PSM) adjusted for selection bias between the two groups.

RESULTS

The incidence of pneumothorax was 26.1% in Group A and 6.4% in Group B. In Group A, 28 patients required chest tube placement, compared to 3 patients in Group B. Using gelatin sponge slurry significantly reduced the incidence of PTX (P<0.05). Multivariate logistic regression analysis in the entire cohort showed that emphysema, smaller tumor size, greater puncture depth, traversing the interlobar fissure, and not using gelatin sponge slurry were significantly associated with increased PTX risk. Within-group multivariate analysis indicated that emphysema, tumor size, puncture depth, and traversing the interlobar fissure were PTX risk factors in Group A. Puncture depth was the sole risk factor in Group B. The incidence of PH was 37.6% in Group A and 38.3% in Group B (P=0.825). Significant pulmonary hemorrhage rates were 14.8% in Group A and 10.6% in Group B (P=0.078). Only one patient in Group A required hemostatic intervention under digital subtraction angiography (DSA). Multivariate logistic regression analysis for the entire cohort identified tumor size and puncture depth as independent prognostic factors for PH. Similar results were observed in within-group analyses. Subgroup analysis revealed that using gelatin sponge slurry did not reduce PTX incidence when puncture depth exceeded 7 cm. For tumors larger than 40 mm and puncture depths ≤7 cm, using gelatin sponge slurry reduced PH incidence.

CONCLUSION

For patients preoperatively identified as at high risk for pneumothorax and pulmonary hemorrhage, using gelatin sponge slurry to seal the needle tract significantly reduces the incidence of these complications.