874df456-0334-4013-be77-fab43b77eb3b by huanghengdong


									Is CT-guided lung biopsy in
  high risk-emphysematic
patients a contraindication?

E. Sotiropoulou , P. Filippousis , S. Apostolopoulou , V. Tsagouli ,
F. Laspas, A. Bouga , I. Tsagaridou , L. Thanos .
Department of Medical Imaging and Interventional Radiology,
"Sotiria" General Hospital of Chest Diseases Athens, Greece.

Transthoracic needle biopsy with imaging
guidance is an established method to diagnose a
variety of thoracic abnormalities.

                                    Y-C Chang et al
                          J Thorac Imaging 2003; 18:21-26

To analyze the influence of multiple variables
on the rate of pneumothorax and chest tube
placement associated with transthoracic
needle aspiration biopsy of the lung in
patients with emphysema.

In 900 patients, computed tomographically
(CT) guided lung biopsies were performed. 90
patients (10%) were emphysematic. Variables
analyzed were lesion size, depth and location;
number of pleural passes; needle size (we used
automatic cutting needle 18G); presence of
emphysema; and training level of the person
who performed the biopsy.
► Pneumothorax    occurred in 20 (22.2%) of 90
  emphysematic patients. Double valve chest tube
  placement was needed in 8 of 20 cases of pneumothorax
► An increased rate of pneumothorax was correlated with
  smaller lesion size.
► Needle size, number of pleural passes, and level of
  training were not correlated with pneumothorax rate.
► Also for peripheral lesions the rate of pneumothorax was
  lower [12 of 90 patients had peripheral lesion and none
  (0%) of them did pneumothorax].
► In 5 patients hemoptysis was observed.

► Pneumothorax   was the most common
► Occurred in 20 of 90 emphysematic patients
► In 8 of 20 cases of pneumothorax (40%)
  required thoracic drainage [8 of 90 biopsied
  patients (8,9%)].
The most common complication of fine needle
aspiration is pneumothorax with incidence that
ranges from 0% to 61%, 20% in most large
series, and the percentage of biopsy patients
requiring treatment of pneumothaorax with
chest tube averages approximately 7%.

                                             Klein et al
                      Radiol Clin North Am 2000; 38:235-266
    In our study pneumothorax rate:

Was correlated with:
► Emphysema
► Smaller  lesion size
► Increased depth size
Was not correlated with:
► Needle size
► Number of pleural passes
► Level of training
  In most series, factors that have been
     associated with a higher risk of
        pneumothorax include :
► increased outer diameter of biopsy needle
► increased depth and decreased size of the lesion
► increased number of times that the thoracic pleura is
► the presence of obstructive airways disease or

                                                Laurent et al
                                      Eur J Radiol 2002; 45:60-68

► Hemorrhage    around the lesion or along the
  needle track was observed on the post-
  biopsy CT slices was the second most
  common complication.
► In 5 patients hemoptysis was observed.
Hemorrhage, with or without hemoptysis, is the
second most common and the most dangerous
potential complication of percutaneous lung
biopsy. The reported incidence of hemorrhage
ranges from 0% to 10%, with most series
reporting an incidence of less than 5%.

                                               Klein et al
                        Radiol Clin North Am 2000; 38:235-266

Emphysema is strongly correlated with
occurrence of pneumothorax. Chest tube
placement was related to the presence of
emphysema. However the degree of collapse is
small and resolves on its own without
treatment. FNA in emphysematic patients
isn’t forbidden for the diagnosis of lung

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