Abstract No. 586 Is the Biosentry tract sealant system effective in reducing pneumothorax rate after computed tomography–guided transthoracic lung biopsy with an 18-gauge biopsy needle?

Abstract

Biosentry tract sealant system (BTS) is a Food and Drug Administration–approved device that deploys a hydrogel plug to seal the pleural puncture after CT-guided transthoracic lung biopsy (CTLB). It has been shown to reduce pneumothorax (PTX) rates with a 20G biopsy-19G introducer needle. The purpose of this study is to evaluate if BTS reduces PTX rates in patients undergoing CTLB with 18G biopsy-17G introducer needle (17G/18G system). In this retrospective study, 272 patients (mean age, 69.4 years) underwent CTLB between January 2015 and February 2019 using a 17G/18G system. BTS was used in 125 patients, and no pleural sealant was used in 147. The variables assessed were PTX on postbiopsy CT images or chest x-ray, chest tube insertion, lesion size, pleura to lesion distance, and presence of emphysema. Comparison between the two groups using T-tests with a significance level set at 0.05 was performed. 23 subjects (18%) had a PTX in BTS group compared to 38 (26%) in controls (P <0.05). 4 patients (17%) required a chest tube in the BTS group, and 3 (8%) in the control (P = 0.28). Mean lesion size in those with PTX was 1.62 cm in the BTS group and 2.44 cm in controls (P = 0.27). Mean pleura to lesion distance in those with PTX was 2.23 cm in the BTS group and 1.52 cm in controls (P = 0.17). Emphysema was present in 47% of patients in the BTS group and 30% in control group (P < 0.05). BTS reduced the pneumothorax rates in CTLB patients with a 17G/18G biopsy system, despite a higher proportion of emphysema patients in BTS group compared to controls. However, the rate of chest tube insertion did not change, in contrast to previous studies in which 19G/20G biopsy systems were used. Additionally, PTX rate was not affected by lesion size or pleura to lesion distance.Table 1BTS (n = 125)Controls (n = 147)PMean/StdDevMean/StdDevPTX rate0.18/0.030.26/0.04<0.05Chest tube insertion rate0.17/0.380.08/0.270.28Lesion size in PTX subjects (cm)1.62/1.122.4/3.50.27Pleura to lesion distance in PTX subjects (cm)2.23/2.231.5/1.80.17% with Emphysema4730<0.05PTX = Pneumothorax, StdDev = Standard Deviation Open table in a new tab