Hemorrhagic Adverse Events of Transthoracic Needle Biopsy of the Lung in Patients with Pulmonary Hypertension: A Systematic Review and Meta-Analysis

Abstract

PurposeTo compare the risk of hemorrhagic adverse events of transthoracic needle biopsy (TTNB) such as pulmonary hemorrhage and hemoptysis between patients with pulmonary hypertension (PH) and patients without PH. Materials and MethodsDatabase search and citation review of search results were performed for studies reporting frequency of hemorrhagic adverse events of TTNB in adult patients with evidence of PH compared with that in patients undergoing the procedure without evidence of PH. Random-effects meta-analysis was performed for both rates of pulmonary hemorrhage and hemoptysis. ResultsA total of 5 studies (encompassing 6,250 patients who underwent 6,684 biopsies) were included. All studies were retrospective and used computed tomography (CT) or echocardiography for identification of signs of PH. Biopsy-related pulmonary hemorrhage was diagnosed radiographically, and postbiopsy hemoptysis was diagnosed by documentation in the medical record. There were no differences found between patients with evidence of PH and those without regarding rates of pulmonary hemorrhage (odds ratio [OR], 1.12 [95% confidence interval {CI}, 0.85–1.47] in studies that used CT to define PH, and OR, 0.88 [95% CI 0.56–1.39] in studies that used echocardiography to define PH). There were also no differences in the rates of hemoptysis (OR, 0.95 [95% CI, 0.46–1.97]). ConclusionsA systematic review and meta-analysis of the literature did not demonstrate that patients with imaging evidence of PH undergoing TTNB had an increased risk of hemorrhagic adverse events.