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Lack of Effect of Position Restriction after Transthoracic Biopsy

Department of Radiology, Centre Hospitalier de l’Université de Montréal, Hôpital Saint-Luc, 1058 rue Saint-Denis, Montréal, Québec, Canada H2X 3J4, e-mail: chartrandlef@videotron.ca

Editor:

We read with great interest the article by Dr Collings and colleagues in the January 1999 issue of Radiology (1).

In their study, Dr Collings and colleagues found no substantial differences regarding the incidence of postbiopsy pneumothorax or the need for chest tube placement after biopsy with respect to whether the puncture site in the patient was placed in a dependent or nondependent position after transthoracic biopsy. Conclusions from their data differ from the generally accepted opinion that, after the procedure, the puncture-site–down position reduces the risk of pneumothorax and chest tube placement (2,3). The authors conclude that patients can be maintained in the most comfortable recumbent position after transthoracic biopsy on the basis of their personal preference, regardless of the puncture site.

In our tertiary center, we retrospectively reviewed findings of 177 consecutive transthoracic biopsies performed with computed tomographic (CT) guidance from April 1998 to March 1999. During this period, four of nine radiologists performing transthoracic biopsies restricted, as part of their usual postbiopsy care, the position of their patients to the recumbent position with puncture site dependency. The five remaining radiologists did not restrict the position of their patients after biopsy, also as part of their usual postbiopsy care. Almost all of their patients spontaneously laid in a supine decubitus position or in a less than half-sitting position.

During the study period, from the total of 177 patients, 103 were assigned a recumbent puncture-site–down position after biopsy (49 supine, 26 prone, and 28 lateral decubitus). In 74 patients, there was no positional restriction. Patient positional choice in the unrestricted group was not recorded. However, if all patients in that group had chosen the supine position, 37 would have been dependent and 37 would have been nondependent, according to their puncture site location.

In the 177 patients, 63 (35.6%) postbiopsy pneumothoraces were recorded, with a mean pneumothorax diameter of 2.19 cm and with six (3.4%) patients requiring chest tube placement. For the positionally restricted group (103 patients), those values were 41 (39.8%), 2.04 cm, and three (2.9%). For the unrestricted group (74 patients), values were 22 (29.7%), 2.48 cm, and three (4.1%). For these three variables, no significant difference was found between the two groups (pneumothoraces, ² = 1.91, P > .1; diameter, F = 2.63, P = .11; chest tube placement, ² = .17, P > .1).

When we considered only the patients in the unrestricted group (74 patients), we found no statistical differences between the incidence of pneumothorax (² = 0.26, P > .1) or the incidence of chest tube placement (² = 0.35, P > .1), whether the patient was in a dependent (inferred, puncture site most dorsal, 37 patients, 10 pneumothoraces, one chest tube) or a nondependent position (inferred, puncture site most ventral, 37 patients, 12 pneumothoraces, two chest tubes).

In summary, our retrospective data, as those of the article by Dr Collings and colleagues, suggest that patients can remain recumbent in the most comfortable position for them after transthoracic biopsy, regardless of the puncture site.

REFERENCES

1. Collings CL, Westcott JL, Banson NL, Lange RC. Pneumothorax and dependent versus nondependent patient position after needle biopsy of the lung. Radiology 1999; 210:59-64.[Abstract/Free Full Text]
2. Moore EH, LeBlanc J, Montesi SA, Richardson ML, Shepard JA, McLoud TC. Effect of patient positioning after needle aspiration lung biopsy. Radiology 1991; 181:385-387.[Abstract/Free Full Text]
3. Moore EH. Technical aspects of needle aspiration lung biopsy: a personal perspective. Radiology 1998; 208:303-318.[Free Full Text]

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