Computed tomography-guided lung biopsy with the patient in lateral decubitus position and the biopsy side down: effect on pneumothorax rate and clinical significance

Dimitrios K Filippiadis, Georgios Velonakis, Alexis Kelekis, Nikolaos Kelekis

Abstract


Purpose: The purpose of our study is to assess the effect of patient positioning (prone or supine versus lateral decubitus position) upon the rate of pneumothorax, during computed tomography (CT)–guided trans-thoracic needle biopsy of pulmonary lesions.

Material and Methods: We retrospectively reviewed data from CT-guided lung biopsies (249 patients) performed in our department during the last four years. 186 biopsies were performed with the patient on prone or supine position (Group A) and 63 were performed with the patient placed on lateral decubitus position with the biopsy-side down (Group B). Statistical analysis was performed between the two groups for pneumothorax, including patient demographic characteristics, lesion characteristics, and biopsy technique. We also compared the results of biopsies performed by the same interventional radiologist between groups.

Results: An increased number of pneumothorax was noted in Group A [29 (15.6%)] compared to Group B [1 (1.6%) p=0.003]. There was also an increased number of drainage catheter insertions in Group A compared to Group B [11 (5.9%) versus 0 (0%), respectively, p=0.048]. Higher rates of pneumothorax (14.7%) and pneumothorax requiring treatment (6.7%) were also noticed in biopsies of group A performed by the same interventional radiologist who performed biopsies in group B, compared to biopsies in contralateral position, and these differences were statistically significant (p=0.007 and p=0.037).Lesion size and emphysema along the needle track were independent risk factors for pneumothorax in group A. Emphysema along the needle track was an independent predictor for insertion of a drainage catheter in Group A. No independent predictor was identified for pneumothorax or insertion of a drainage catheter in Group B.

Conclusions: Performing percutaneous CT-guided trans-thoracic lung biopsy with the patient placed on lateral decubitus position with the biopsy-side down reduces the rate of pneumothorax and pneumothorax necessitating a drainage catheter. Application of this technique attenuates the influence of traditional risk factors for pneumothorax. 


Keywords


pneumothorax; lung; biopsy; position; lateral

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References


Gupta S, Wallace MJ, Cardella JF, et al. Society of Interventional Radiology Standards of Practice Committee. Quality improvement guidelines for percutaneous needle biopsy. J Vasc Interv Radiol 2010; 21(7): 969-975.

Geraghty PR, Kee ST, McFarlane G, et al. CT-guided transthoracic needle aspiration biopsy of pulmonary nodules: needle size and pneumothorax rate. Radiology 2003; 229 (2): 475-481.

Manhire A, Charig M, Clelland C, et al. Guidelines for radiologically guided lung biopsy. Thorax 2003; 58 (11): 920-936.

Covey AM, Gandhi R, Brody LA, et al. Factors associated with pneumothorax and pneumothorax requiring treatment after percutaneous lung biopsy in 443 consecutive patients. J Vasc Interv Radiol 2004; 15: 479-483.

Hiraki T, Mimura H, Gobara H, et al. Incidence of and risk factors for pneumothorax and chest tube placement after CT fluoroscopy–guided percutaneous lung biopsy: retrospective analysis of the procedures conducted over a 9-year period. AJR Am J Roentgenol 2010; 194: 809-814.

Tomiyama N, Yasuhara Y, Nakajima Y, et al. CT guided needle biopsy of lung lesions: a survey of severe complication based on 9783 biopsies in Japan. Eur J Radiol 2006; 59: 60–64.

Wagner JM, Hinshaw JL, Lubner MG, et al. CT-guided lung biopsies: pleural blood patching reduces the rate of chest tube placement for postbiopsy pneumothorax. AJR Am J Roentgenol 2011; 197(4): 783-788.

Ko J P, Shepard J O, Drucker E A, et al. Factors influencing pneumothorax rate at lung biopsy: are dwell time and angle of pleural puncture contributing factors? Radiology 2001; 218: 491–496.

Saji H, Nakamura H, Tsuchida T, et al. The incidence and the risk of pneumothorax and chest tube placement after percutaneous CT-guided lung biopsy: the angle of the needle trajectory is a novel predictor. Chest 2002; 121: 1521–1526.

Lorenz J, Blum M. Complications of percutaneous chest biopsy. Semin Intervent Radiol 2006; 23(2): 188-193.

Zidulka A, Braidy TF, Rizzi MC, et al. Position may stop pneumothorax progression in dogs. Am Rev Respir Dis 1982; 126 (1): 51-53.

Moore EH, Shepard JA, McLoud TC, et al. Positional precautions in needle aspiration lung biopsy. Radiology 1990; 175 (3): 733-735.

Moore EH, LeBlanc J, Montesi SA, et al. Effect of patient positioning after needle aspiration lung biopsy. Radiology 1991; 181 (2): 385-387.

Moore EH. Technical aspects of needle aspiration lung biopsy: a personal perspective. Radiology 1998; 208 (2): 303-318.

O’Neill AC, McCarthy C, Ridge CA, et al. Rapid needle-out patient-rollover time after percutaneous CT-guided transthoracic biopsy of lung nodules: effect on pneumothorax rate. Radiology 2012; 262(1): 314-319.

Collings CL, Westcott JL, Banson NL, et al. Pneumothorax and dependent versus nondependent patient position after needle biopsy of the lung. Radiology 1999; 210 (1): 59-64.

Berger R, Smith D. Efficacy of the lateral decubitus position in preventing pneumothorax after needle biopsy of the lung. South Med J 1988; 81(9): 1140-1143.

Rozenblit AM, Tuvia J, Rozenblit GN, et al. CT-guided transthoracic needle biopsy using an ipsilateral dependent position. AJR Am J Roentgenol 2000; 174(6): 1759-1764.

Kinoshita F, Kato T, Sugiura K, et al. CT-guided transthoracic needle biopsy using a puncture site-down positioning technique. AJR Am J Roentgenol 2006; 187(4): 926-932.

Zidulka A. Position may reduce or stop pneumothorax formation in dogs receiving mechanical ventilation. Clin Invest Med 1987; 10(4): 290-294.

Masterson AV, Haslam P, Logan PM, et al. Patient positioning after lung biopsy: influence on the incidence of pneumothorax. Can Assoc Radiol J 2003; 54(1): 31-34.

Nakamura M, Yoshizako T, Koyama S, et al. Risk factors influencing chest tube placement among patients because of CT guided needle biopsy of the lung. J Med Imaging Radiat Oncol 2011; 55(5): 474-478.

Patel IJ, Davidson JC, Nikolic B, et al. Standards of Practice Committee, with Cardiovascular and Interventional Radiological Society of Europe (CIRSE) Endorsement; Standards of Practice Committee of the Society of Interventional Radiology. Addendum of newer anticoagulants to the SIR consensus guideline. J Vasc Interv Radiol 2013; 24(5): 641-645.

Malloy PC, Grassi CJ, Kundu S, et al. Standards of Practice Committee with Cardiovascular and Interventional Radiological Society of Europe (CIRSE) Endorsement. Consensus guidelines for periprocedural management of coagulation status and hemostasis risk in percutaneous image-guided interventions. J Vasc Interv Radiol 2009; 20(7 Suppl): 240-249.

Wang Y, Li W, He X, et al. Computed tomography guided core needle biopsy of lung lesions: diagnostic yeld and correlation between factors and complications. Oncol Lett 2014; 7(1): 288-294.

Herman SJ, Weisbrod GL. Usefulness of the blood patch technique after transthoracic needle aspiration biopsy. Radiology 1990; 176: 395–397.

Lang EJ, Ghavami R, Schreiner VC, et al. Autologous blood clot seal to prevent pneumothorax at CT-guided lung biopsy. Radiology 2000; 216: 93–96.


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