The yield of immediate post lung biopsy CT in predicting iatrogenic pneumothorax

Rafael Y. Brzezinski, Ifat Vigiser, Irina Fomin, Lilach Israeli, Shani Shenhar-Tsarfaty, Amir Bar-Shai*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

Background: The most prevalent complication of percutaneous lung biopsy is pneumothorax (PNX). A routine immediate post-procedure CT scan (ICT) to spot PNX is done in many centers. However, the diagnostic yield of this practice has not been studied broadly. We sought to evaluate whether an ICT could replace the routine follow-up chest X-ray (CXR) in detecting procedure related PNX. Methods: We examined case-records of 453 patients who underwent lung biopsy at our medical center. We analyzed findings from CXR performed 2-h after biopsy and from CT images at the site of biopsy acquired immediately after the procedure (ICT). Multivariate analysis was used to identify the risk factors for PNX, and we examined the concordance between ICT and CXR-2-h post-procedure. Results: A total of 87 patients (19%) were diagnosed with PNX on CXR-2-h post-procedure. ICT detected 80.5% of diagnosed PNX (p < 0.01). However, ICT demonstrated a negative predictive value of only 94%, meaning 17 patients (6%) with a negative ICT did eventually develop PNX seen on CXR. Furthermore, bleeding surrounding the puncture area spotted on ICT negatively predicted the development of PNX (OR = 0.4 95% CI; 0.2-0.7). Conclusions: We conclude that a CT scan performed immediately after percutaneous lung biopsy cannot replace the routine follow-up CXR in predicting iatrogenic PNX. Bleeding in the needle's tract may lower the risk for procedure-related PNX.

Original languageEnglish
Article number11288
JournalBMC Pulmonary Medicine
Volume20
Issue number1
DOIs
StatePublished - 15 Apr 2020

Keywords

  • Biopsy
  • Complications
  • Computed tomography
  • Lung cancer
  • Pneumothorax

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