Bronchovascular injury associated with clinically significant hemoptysis after CT-guided core biopsy of the lung: Radiologic and histopathologic analysis.

Heekyung Kim,Soon Ho Yoon,Su Yeon Ahn,Hyungjin Kim,Chang Min Park,Jin Mo Goo,Dohee Kwon,Yoon Kyung Jeon,Ruud Veldhuizen

doi:10.1371/journal.pone.0204064

Heekyung Kim, Soon Ho Yoon + Show 7 more

Open Access

https://doi.org/10.1371/journal.pone.0204064

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Journal: PloS one	Publication Date: Sep 21, 2018
Citations: 12	License type: CC BY 4.0

Affiliation: Seoul National University

Abstract

ObjectiveTo evaluate bronchovascular injuries as the causative occurrence for clinically significant hemoptysis after percutaneous transthoracic needle biopsy (PTNB).Materials and methodsWe included 111 consecutive patients who experienced hemoptysis after cone beam CT (CBCT)-guided PTNB from January 2014 through January 2017. Clinically significant hemoptysis was defined as hemoptysis causing hemodynamic instability or oxygen desaturation greater than 10% of baseline. The lesion characteristics were evaluated on CT images. The penetration of bronchovascular structures along the trajectory of the introducer needle and potential penetration at the firing of the biopsy gun were assessed on CBCT images. The cutting injury of bronchovascular structures was histopathologically assessed in biopsy specimens. The associated factors for clinically significant hemoptysis were assessed using logistic regression analyses.ResultsSeventeen patients (15.3%; 95%CI, 9.7%-23.2%) had clinically significant hemoptysis. On univariate analysis, the open bronchus sign (P = .004), nodule consistency (P = .012), potential penetration of a pulmonary vessel or bronchus 1 mm or larger at firing (P = .008 and P = .038, respectively), and a cutting injury of a pulmonary vessel 1 mm or larger (P = .007) or a bronchial structure (P = .041) were associated with clinically significant hemoptysis. Multivariate analysis found the following significant associated factors: potential penetration of a pulmonary vessel 1 mm or larger at firing (OR, 3.874; 95%CI, 1.072–13.997; P = .039) and cutting injury of a pulmonary vessel 1 mm or larger (OR, 6.920; 95%CI, 1.728–27.711; P = .006) or a bronchial structure (OR 4.604; 95%CI, 1.194–17.755; P = .027).ConclusionPotential penetration and cutting injury of bronchovascular structures 1mm or larger at firing were independently associated with clinically significant hemoptysis after PTNB.

Highlights

Percutaneous transthoracic needle biopsy (PTNB) has been considered a crucial diagnostic procedure for the pathologic evaluation of peripheral pulmonary lesions in that it is less invasive than surgical lung biopsy and similar to higher diagnostic accuracy than bronchoscopic biopsy [1]
Bronchovascular injury associated with clinically significant hemoptysis after computed tomography (CT)-guided core biopsy
Potential penetration and cutting injury of bronchovascular structures 1mm or larger at firing were independently associated with clinically significant hemoptysis after PTNB

Summary

Introduction

Percutaneous transthoracic needle biopsy (PTNB) has been considered a crucial diagnostic procedure for the pathologic evaluation of peripheral pulmonary lesions in that it is less invasive than surgical lung biopsy and similar to higher diagnostic accuracy than bronchoscopic biopsy [1]. The role of PTNB has been increasing recently for the mutational analysis of non-small cell lung cancer in the era of targeted therapy [3]. PTNB is a safe procedure and is less invasive than surgical lung biopsy, it is inevitably accompanied by a risk of procedure-related complications. The occurrence of an injury to a bronchus or pulmonary vessel during the PTNB procedure has been suggested to be a potential source of fatal hemoptysis [12], but has not been systematically analyzed associated with clinically significant hemoptysis

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