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Vascular and Interventional Radiology |
1 From the Department of Radiology, Massachusetts General Hospital, Boston (J.P.K., J.O.S., E.A.D. S.L.A., E.H., T.C.M.); Barts and the London NHS Trust, England (A.S.); and the University of Texas M.D. Anderson Cancer Center, Houston (B.S.). From the 1999 RSNA scientific assembly. Received February 10, 2000; revision requested March 24; revision received May 5; accepted May 22. Address correspondence to J.P.K., Department of Radiology, NYU Medical Center, 560 1st Ave, New York, NY 10016 (e-mail: jane.ko@med.nyu.edu).
PURPOSE: To study factors that may influence pneumothorax and chest tube placement rate, especially needle dwell time and pleural puncture angle.
MATERIALS AND METHODS: In 159 patients, 160 coaxial computed tomography (CT)-guided lung biopsies were performed. Dwell time, the time between pleural puncture and needle removal, was calculated. The smallest angle of the needle with the pleura ("needle-pleural angle") was measured. These and other variables were correlated with pneumothorax and chest tube rates.
RESULTS: One hundred fifty biopsies were included. There were 58 (39%) pneumothoraces (14 noted only at CT), with eight (5%) biopsies resulting in chest tube placement. Longer dwell times (mean, 29 minutes; range, 12–66 minutes) did not correlate with pneumothoraces (P = .81). Smaller needle-pleural angles (80°), decreased forced expiratory volume in 1 second to vital capacity ratio (<50%), lateral pleural puncture, and lesions along fissures were associated with lower pneumothorax rates (P < .05). Emphysema along the needle path, pulmonary function tests showing ventilatory obstruction, and lesions along fissures predisposed patients to chest tube placement (P < .05). Pleural thickening and prior surgery were associated with lower pneumothorax rates (P < .05).
CONCLUSION: Longer dwell times do not correlate with pneumothorax and should not influence the decision to obtain more biopsy samples. A shallow pleural puncture angle may increase the pneumothorax rate.
Index terms: Biopsies, complications, 60.732 • Computed tomography (CT), guidance, 60.12111 • Lung, biopsy, 60.1263 • Pneumothorax, 60.732
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