Abstract No. 530 The role of chest radiographs post computed tomography–guided lung biopsy with gelatinous foam slurry: is it necessary?

Abstract

To explore whether it is necessary to obtain chest radiographs post CT-guided lung biopsy with gelatinous foam slurry needle track embolization This is an IRB-approved prospective study of 47 patients with lung masses visualized on CT who came to our institution for lung biopsy. At our institution, gelatinous foam with 0.9% sodium chloride is mixed together to create a slurry and administered through a coaxial needle post biopsy. Post biopsy CT is obtained as well as chest radiographs are obtained at 1 and 2 hours post procedure. If a pneumothorax is visualized, the patient is examined clinically and a determination is made whether further intervention with a chest tube is necessary. Of the 47 patients in our study, only one patient had a pneumothorax not visualized on CT (2.1%). 11 patients in our study developed pneumothorax, 10 of which were visualized on CT prior to the patient leaving the CT table and subsequently viewed on the 1 hour and 2 hour post procedure chest radiograph with no significant interval change in size of pneumothorax. One of the known risks of a lung biopsy is pneumothorax. Our study demonstrates a low rate of delayed/developing pneumothorax; one patient of 47 (2.1%). Upon reviewing the images of the one delayed pneumothorax, the lung mass was in the right perihilar region and the final CT image did not extend to the apex and inferior parts of the lung. It is possible that the pneumothorax was there immediately however it may not have been imaged. The trend shown in our study demonstrates that although there is always concern for delayed/developing pneumothorax after lung biopsy with gelatinous foam slurry, the risk is very low. As we continue to add patients to the study, we hope to achieve a large enough sample size to further demonstrate that it may not be necessary to obtain chest radiographs post lung biopsy if the final CT shows no pneumothorax.