Risk factors for pneumothorax and pulmonary hemorrhage following computed tomography-guided transthoracic core-needle biopsy of subpleural lung lesions

Abstract

Identifying the risk factors for complications may alert the physicians and help them adjust their plans before performing computed tomography-guided lung biopsies. Reportedly, a pleura-nodule distance longer than 2.0 cm is a strong predictor for pneumothorax and pulmonary hemorrhage. However, the rate and risk factors of biopsy-associated complications in subpleural lesions have not been assessed. This study aimed to identify the risk factors for pneumothorax and pulmonary hemorrhage in subpleural lesions ≤2.0 cm in depth. Altogether, 196 patients (196 subpleural lesions, lesion depth: 0.1-2.0 cm) who underwent computed tomography-guided transthoracic core-needle biopsies between March 2017 and November 2017 were retrospectively analyzed. Univariate analysis of risk factors including patient-related, lesion-related, and procedure-related characteristics was performed for pneumothorax ≥1 cm and pulmonary hemorrhage ≥2 cm after the biopsy. Multivariate logistic regression analysis was performed to identify the independent risk factors. Pneumothorax ≥1 cm and pulmonary hemorrhage ≥2 cm were identified in 35 (17.9%) and 32 (16.3%) cases, respectively. In the multivariate analysis, a longer needle path (odds ratio [OR], 1.976; 95% confidence interval [CI], 1.113-3.506; p = 0.020) and low attenuation along the biopsy tract (OR, 3.080; 95% CI, 1.038-9.139; p = 0.043) were predictors of pneumothorax ≥ 1 cm. Ground-glass lesions (OR, 2.360; 95% CI, 1.009-5.521; p = 0.048) and smaller needle-pleura angle (OR, 0.325; 95% CI, 0.145-0.728; p = 0.006) were associated with pulmonary hemorrhage ≥2 cm. For subpleural lesions ≤2.0 cm in depth, a puncture route having a shorter needle path and passing through the lung parenchyma with higher attenuation may reduce the risk of biopsy-associated pneumothorax ≥1 cm. A higher needle-pleura angle may reduce the risk of pulmonary hemorrhage ≥2 cm in the short axis.