CT-guided Transthoracic Lung Biopsy Research Articles

Is the BioSentry Tract Sealant System Effective in Reducing the Pneumothorax Rate After CT-Guided Transthoracic Lung Biopsy With an 18G Biopsy Needle?

Is the BioSentry Tract Sealant System Effective in Reducing the Pneumothorax Rate After CT-Guided Transthoracic Lung Biopsy With an 18G Biopsy Needle?

CT-Guided Core and Fine Needle Aspiration Transthoracic Lung Biopsies: Multivariate Analysis of Risk Factors Associated with Pneumothorax and Effect of Dwell Time in Core Biopsies

CT-Guided Core and Fine Needle Aspiration Transthoracic Lung Biopsies: Multivariate Analysis of Risk Factors Associated with Pneumothorax and Effect of Dwell Time in Core Biopsies

A lung biopsy path planning algorithm based on the double spherical constraint Pareto and indicators’ importance-correlation degree

Lung cancer has the highest mortality rate among cancers. The commonly used clinical method for diagnosing lung cancer is the CT-guided percutaneous transthoracic lung biopsy (CT-PTLB), but this method requires a high level of clinical experience from doctors. In this work, an automatic path planning method for CT-PTLB is proposed to provide doctors with auxiliary advice on puncture paths. The proposed method comprises three steps: preprocessing, initial path selection, and path evaluation. During preprocessing, the chest organs required for subsequent path planning are segmented. During the initial path selection, a target point selection method for selecting biopsy samples according to biopsy sampling requirements is proposed, which includes a down-sampling algorithm suitable for different nodule shapes. Entry points are selected according to the selected target points and clinical constraints. During the path evaluation, the clinical needs of lung biopsy surgery are first quantified as path evaluation indicators and then divided according to their evaluation perspective into risk and execution indicators. Then, considering the impact of the correlation between indicators, a path scoring system based on the double spherical constraint Pareto and the importance-correlation degree of the indicators is proposed to evaluate the comprehensive performance of the planned paths. The proposed method is retrospectively tested on 6 CT images and prospectively tested on 25 CT images. The experimental results indicate that the method proposed in this work can be used to plan feasible puncture paths for different cases and can serve as an auxiliary tool for lung biopsy surgery.

Association between needle track bleeding and postoperative immediate pneumothorax in CT-guided percutaneous transthoracic lung biopsies: a cross-sectional study

The relationship between Needle Track Bleeding (NTB) and the occurrence of postoperative immediate pneumothorax remains unclear. In our cross-sectional study, we conducted a retrospective collected of data from 674 consecutive patients who underwent CT-guided percutaneous transthoracic lung biopsies between 2019 and 2022. A logistic regression model was employed to explore the association between NTB and postoperative immediate pneumothorax, and restricted cubic spline curves was used to investigate the link and its explicit curve shape. A sensitivity analysis was performed by transforming the continuous NTB into categorical variable and calculated an E-value. A total of 453 participants (47.90% male) were included in our analysis. The postoperative immediate pneumothorax rate was 41.05% (186/453). We found a negative correlation between NTB and postoperative immediate pneumothorax (OR = 0.91, 95%CI 0.88–0.95) after adjusting for confounding factors. This relationship was nonlinear, with a key inflection point at NTB of 8 mm. No significant link was noted for NTB > 8 mm (OR = 0.98, 95%CI 0.95–1.02), while a protective association was observed for NTB ≤ 8 mm (OR = 0.74, 95%CI 0.66–0.81). NTB showed a nonlinear, protective correlation with postoperative immediate pneumothorax. However, when NTB exceeded 8 mm, the protective association was not observed.

CT-based radiomics for prediction of pulmonary haemorrhage after percutaneous CT-guided transthoracic lung biopsy of pulmonary nodules

To evaluate the feasibility of intranodular and perinodular computed tomography (CT) radiomics features for predicting the occurrence of pulmonary haemorrhage after percutaneous CT-guided transthoracic lung biopsy (PCTLB) in pulmonary nodules. The data for 332 patients with pulmonary nodules who underwent PCTLB were reviewed retrospectively. Pulmonary haemorrhage after PCTLB was evaluated using CT (144 cases occurred). Radiomics features based on gross nodular (GNV) and perinodular volumes (PNV) were extracted from pre-biopsy CT images and features selection using least absolute shrinkage and selection operator (LASSO) regression, and three radiomics scores (rad-scores) were built. Rad-scores, clinical, and clinical-radiomic models were developed and evaluated to predict the occurrence of pulmonary haemorrhage. Five, five, and six significant features were selected for prediction of pulmonary haemorrhage based on GNV, PNV, and GNV+PNV, respectively. Lesion depth was the only clinical characteristics related to pulmonary haemorrhage. Lesion depth and rad-score based on GNV, PNV, and GNV+PNV for predicting the pulmonary haemorrhage achieved areas under the curves (AUCs) of 0.656, 0.645, 0.651, and 0.635 in the validation group, respectively. Three clinical-radiomic models improved the AUCs to 0.743, 0.723, and 0.748. The performance of rad-score_GNV+PNV combined with lesion depth outperformed the clinical model (p=0.024) and the radiomics signature (p=0.038). In addition, the radiomics signatures were significantly associated with higher-grade pulmonary haemorrhage (p<0.05). Radiomics features from intranodular and perinodular regions of pulmonary nodules have good predictive ability for pulmonary haemorrhage after PCTLB, which may provide additional predictive value for clinical practice.

Variation in Incidence of Pneumothorax Complications After Percutaneous Lung Biopsies Among Veterans Health Administration Hospitals

Variation in Incidence of Pneumothorax Complications After Percutaneous Lung Biopsies Among Veterans Health Administration Hospitals

CT-guided Transthoracic Lung Biopsy: complications and success in yielding a specific diagnosis

Aim: To present risk factors for common complications of CT-guided transthoracic lung biopsy and to analyse the diagnostic success of the procedure in terms of specific diagnostic rates. Materials &amp; Methods: 461 consecutive procedures retrospectively enrolled. Patient, lesion and technical variables are scrutinized in terms of complications and their severity. Pathology results were evaluated for diagnostic specificity. Results: 27% total complications with %17 alveolar haemorrhage, 7% pneumothorax and 3% developed both. ≤ 15 mm size and ≥ 20 mm distance from pleura significantly increases the risk of both PTX and AH. Perilesional emphysema is a predisposing factor of both severe PTX and extended bleeding. Lateral decubitus position increases the likelihood of pneumothorax. Patients with a needle angle of less than 90±15° had an approximate 2-fold increase risk of PTX (P = 0.034). Semi-solid lesions carry a risk of significant bleeding. The accuracy was 96.9% with a specific malignant diagnosis rate of 83% and a specific benign diagnosis rate of 52%. Conclusion: Perilesional emphysema is risk factor of severe complications. Semi-solid lesions are prone to severe bleeding. Lateral decubitus position and low needle angle are important as preventable predisposing factors of PTX. Although the diagnostic yield is satisfactory, the specific benign diagnosis rates are still below expectations and that larger needle biopsies are more beneficial in this regard.

Safety, feasibility, and effectiveness of a CT-guided transthoracic lung and pleural biopsy - a single-centre experience with own low-dose protocol.

To assess the efficacy and safety of a low-dose, computed tomography (CT)-guided transthoracic biopsy of lung and pleural lesions. A total of 135 low-dose, CT-guided transthoracic lung and pleural lesions biopsies were performed. A cutting needle was utilized in 124 cases, and fine needle aspiration biopsy was performed in 14 cases. In all cases, 14- to 22-gauge biopsy needles were used. Diagnostic material was obtained in 111 (82.2%) patients. In 97 (71.8%) cases neoplastic lesions were found, predominantly adenocarcinoma and non-small cell carcinoma. In 14 (12.6%) cases non atypical cells were reported. Biopsy failed to obtain material suitable for histopathological examination in 24 (17.7%) cases. Complications occurred in 31 patients, including pneumothorax in 28 patients and haematoma in 3 cases. Based on the obtained results, it can be stated that low-dose, CT-guided transthoracic biopsy of lung and pleural tissues is an accurate and safe procedure. Also, it is linked to a low risk of complications such as a small pneumothorax.

Transtorasik Akciğer Biyopsisi: Tek Bir Merkezdeki İlk Deneyimlerin Retrospektif Değerlendirmesi

Background: To evaluate our first experience on computed tomography (CT)-guided transthoracic lung biopsy and compare our results including complication rates, etc. with the literature. Materials and Methods: Thirty-four CT-guided transthoracic biopsies in 33 consecutive patients with lung lesions using a 15 cm long 16 gauge semi-automatic (coaxial) biopsy needle were retrospectively evaluated. Age, gender, size of the lesion, location, distance to pleura, needle insertion angle, patient position, presence of emphysema and/or complications (pneumothorax and pulmonary hemorrhage), radiological findings before, during and after the biopsy,and pathological diagnosis were retrieved from patient files. The diagnostic success and failure of the method, and complication rates were noted. Results: Pneumothorax and pulmonary hemorrhage were observed in 9 and 7 patients, respectively, and 4 patients had both. Application of a chest tube was necessary in only 4 patients (4 of 9 patients wirth pneumothorax). None of the patients with pulmonary hemorrhage required additional procedures. The biopsy sample was adequate for histopathologic evaluation in 32 patients with a diagnostic accuracy rate of 96.6%. The most frequent diagnosis was squamous cell carcinoma (11/33), followed by other types of primary lung tumors in 14, breast carcinoma metastasis in 2, and B-cell lymphoma in 1 patient. Conclusions: Our rate of complication due to CT-guided transthoracic lung biopsy seems to be comparable with the literature. Pneumothorax and pulmonary hemorrhage may occur in up to one fifth/fourth but the management of these complications does not require additional procedures in the majority of patients, and the diagnostic accuracy rate is high.

Efficacy and Safety Analysis of Multislice Spiral CT-Guided Transthoracic Lung Biopsy in the Diagnosis of Pulmonary Nodules of Different Sizes

Objective. This study is aimed at investigating the efficacy and safety of multislice spiral CT-guided transthoracic lung biopsy in the diagnosis of pulmonary nodules of different sizes. Methods. Data of 78 patients with pulmonary nodules who underwent CT-guided transthoracic lung biopsy in our hospital from January 2020 to December 2021 were retrospectively analyzed, and they were divided into the small nodules group ( n = 12 ), medium nodules group ( n = 35 ), and large nodules group ( n = 31 ) according to the diameter of pulmonary nodules. The results of puncture biopsy and final diagnosis of pulmonary nodules of different sizes were compared. The incidence of complications in patients with pulmonary nodules of different sizes was compared. Univariate analysis was used to compare the incidence of complications in 78 patients. Logistic multiple regression analysis was used to analyze the independent risk factors of pneumothorax in patients with pulmonary nodule puncture. Logistic multiple regression analysis was used to analyze the independent risk factors of pulmonary hemorrhage in patients with pulmonary nodule puncture. Results. The diagnostic accuracy, sensitivity, and specificity were 83.33%, 100.00%, and 77.78% in small nodules group. The diagnostic accuracy, sensitivity, and specificity of medium nodules group were 85.71%, 100.00%, and 73.68%, respectively. The diagnostic accuracy, sensitivity, and specificity of large nodules group were 93.55%, 100.00%, and 33.33%, respectively. There was no significant difference in the incidence of pneumothorax among the three groups ( P &gt; 0.05 ). The incidence of pulmonary hemorrhage in small nodule group was higher than that in the medium nodule group and large nodule group, and the difference was statistically significant ( P &lt; 0.05 ). There was no significant difference in the incidence of total complications among the three groups ( P &gt; 0.05 ). There were statistically significant differences in clinical data such as the needle tract length, the puncture position, and the distance of the puncture needle passing through the lung tissue in patients with or without pneumothorax ( P &lt; 0.05 ). There were statistically significant differences in needle tract length, distance of puncture needle passing through lung tissue, and size of pulmonary nodules in patients with or without pulmonary hemorrhage ( P &gt; 0.05 ). Logistic multivariate analysis showed that needle tract length ≤ 50 mm , lateral decubitus position, and the distance of puncture needle passing through lung tissue ≥ 14 mm were independent risk factors for pneumothorax after puncture in patients with pulmonary nodules ( P &lt; 0.05 ). The needle tract length &gt; 50 mm , the distance of puncture needle passing through lung tissue ≥ 14 mm , and small nodules (pulmonary nodules diameter ≤ 10 mm ) were independent risk factors for pulmonary hemorrhage after puncture in patients with pulmonary nodules ( P &lt; 0.05 ). Conclusion. Multislice spiral CT-guided transthoracic lung biopsy is effective in diagnosing pulmonary nodules of different sizes.

Biopsy-tract haemocoagulase injection reduces major complications after CT-guided percutaneous transthoracic lung biopsy

To determine whether the injection of haemocoagulase into the biopsy tract can reduce pneumothorax and pulmonary haemorrhage after computed tomography (CT)-guided percutaneous transthoracic lung biopsy (PTLB). A retrospective study was performed involving patients with undiagnosed pulmonary lesions scheduled for PTLB between January 2020 and March 2021. Patients were assigned to the haemocoagulase group or the non-haemocoagulase group. After CT-guided biopsies were performed with a 17 G coaxial system, patients in the haemocoagulase group received a haemocoagulase injection (0.2-0.5 units) in the biopsy tract as the sheath was withdrawn. Postoperative image studies were performed to evaluate complications, including pneumothorax and pulmonary haemorrhage. Factors, including the patient's position, lesion location, and pathological results, were evaluated to determine their associations with the complications. A total of 100 patients were included, with 44 men and a mean age of 53 years old. The overall incidences of pneumothorax and pulmonary haemorrhage were 15% and 13%, respectively. The incidences of pneumothorax and pulmonary haemorrhage were statistically significantly lower in the haemocoagulase group (8% and 6%, respectively) than in the non-haemocoagulase group (22% and 20%, respectively; p=0.04 and 0.03, respectively). There was no statistically significant difference in haemoptysis between the haemocoagulase (6%) and non-haemocoagulase (2%) groups (p=0.23). There were also no statistically significant associations of pneumothorax or pulmonary haemorrhage with the patients' positions, lesion location, or pathological results. Biopsy tract haemocoagulase injection reduced the incidences of postoperative pneumothorax and pulmonary haemorrhage after PTLB.

CT-Guided Transthoracic Biopsy of Pulmonary Lesions: Diagnostic versus Nondiagnostic Results.

(1) Background: Despite the high accuracy of CT-guided transthoracic biopsy for diagnosis of pulmonary lesions, in a certain amount of cases biopsy results may indicate the presence of nonspecific findings or insufficient material. We aimed to investigate the effectiveness of CT-guided transthoracic biopsy of pulmonary lesions in providing a specific diagnosis and to analyze the variables affecting biopsy results. (2) Methods: In this retrospective study, a total of 170 patients undergoing 183 CT-guided transthoracic biopsies of pulmonary lesions were included. The clinical, radiological and pathological data were reviewed to classify biopsy results as diagnostic or nondiagnostic and to identify which variables were associated with the two groups. (3) Results: The biopsy results were diagnostic in 150 cases (82.0%), of which 131 (87.3%) positive for malignancy and 19 (12.7%) with specific benign lesions, and nondiagnostic in 33 cases (18.0%). Twenty-two of the thirty-three (66.7%) nondiagnostic cases were finally determined as malignancies and eleven (33.3%) as benign lesions. In the diagnostic group, all the 131 biopsies positive for malignancy were confirmed to be malignant at final diagnosis (87.3%); of 19 biopsies with specific benign lesions, 13 cases were confirmed to be benign (8.7%), whereas six cases had a final diagnosis of malignancy (4%). Multivariate analysis showed increased risk of nondiagnostic biopsy for lesions ≤ 20 mm (p = 0.006) and lesions with final diagnosis of benignity (p = 0.001). (4) Conclusions: CT-guided transthoracic lung biopsy is an effective technique for the specific diagnosis of pulmonary lesions, with a relatively acceptable proportion of nondiagnostic cases. Small lesion size and final benign diagnosis are risk factors for nondiagnostic biopsy results.

QUALITY IMPROVEMENT INITIATIVE TO REDUCE THE RATES OF CHEST TUBE FAILURE IN MANAGEMENT OF IATROGENIC PNEUMOTHORAX FOLLOWING CT-GUIDED LUNG BIOPSY

TOPIC: Procedures TYPE: Original Investigations PURPOSE: Iatrogenic pneumothorax following Interventional Radiology (IR) CT-guided transthoracic lung biopsy is a frequent complication with reported rates between 12-45% of which 2-15% will require thoracostomy tube placement. Recently, smaller tube sizes have been made commercially available, but it is unclear if these tubes are as efficacious and safe as larger chest tubes in the management of iatrogenic pneumothorax following lung biopsy. A previous quality assessment project at our institution demonstrated higher failure rates in chest tubes of less than 10 French (Fr). Our objective was to reduce the incidence of chest tube failure when managing iatrogenic pneumothorax after CT-guided lung biopsy via IR. METHODS: After demonstrating a failure rate in smaller bore chest tubes, we met with our interventional radiology colleagues and decided to place 10 Fr chest tubes or larger after iatrogenic pneumothorax following CT-guided lung nodule biopsies. As with our previous quality assessment project, we then retrospectively completed a chart review from January 2018 to March 2021 on all IR CT-guided lung nodules biopsied and identified cases of iatrogenic pneumothorax requiring chest tube placement and those with chest tube failure. We again defined chest tube failure as expanding pneumothorax requiring additional chest tube insertion or tension pneumothorax. RESULTS: In the pre-intervention group, there were a total of 7 chest tubes of less than 10 Fr and 5 chest tube failures in the 78 cases that required chest tube insertion (9% & 6% respectively). In the post-intervention group, no catheters smaller than 10 Fr were placed and there were no chest tube failures in the 54 cases that required chest tube insertion (0%); 6 (11%) individuals had a 10 Fr, 7 (13%) had a 12 Fr, and the remaining 41 (76%) had a 14 Fr chest tube inserted. The absence of chest tubes smaller than 10 Fr in the post-intervention group was statistically significant (p=0.02). There were no failures in the post-intervention group compared to 6% in the pre-intervention group (p=0.06). CONCLUSIONS: This analysis suggests a reduction in complication rates with the use of chest tubes 10 Fr or larger in management of iatrogenic pneumothorax from CT guided lung biopsy. This quality improvement project has demonstrated a significant change in practice habits with a trend toward reduced failure rates. A larger analysis will be needed to examine the statistical significance of reduced complications after intervention. CLINICAL IMPLICATIONS: This study demonstrated a change in practice habits toward larger sized chest tubes in the management of iatrogenic pneumothorax from CT-guided lung nodule biopsy. A larger analysis will be needed to demonstrate optimal chest tube size. DISCLOSURES: No relevant relationships by hassan Al-Balas, source=Web Response No relevant relationships by Stephen Bujarski, source=Web Response No relevant relationships by Sunjay Devarajan, source=Web Response No relevant relationships by James Ramey, source=Web Response No relevant relationships by Sarah Tuthill, source=Web Response

Accuracy and complications of percutaneous transthoracic needle lung biopsy for the diagnosis of malignancy in patients with idiopathic pulmonary fibrosis.

To determine the accuracy of CT-guided percutaneous transthoracic needle lung biopsy (PTNB) for the diagnosis of malignancy and the associated complication rates in patients with idiopathic pulmonary fibrosis (IPF). This retrospective study included 91 CT-guided PTNBs performed in 80 patients with IPF from April 2003 through December 2016. Data regarding patients, target lesions, procedures, complications, and pathological reports were collected, and the final diagnosis was made. The diagnostic accuracy, sensitivity, specificity, percentage of nondiagnostic results, and complication rates were determined. Multivariable logistic regression analyses were performed to identify risk factors for nondiagnostic results and major complications. Three biopsies (technical failure [n = 2] and undetermined final diagnosis [n = 1]) were excluded from the diagnostic accuracy calculation. The diagnostic accuracy, sensitivity, and specificity were 89% (78/88), 90% (62/69), and 84% (16/19), respectively. The percentage of nondiagnostic results was 34% (30/88). Lesion size ≤ 3 cm (odds ratio [OR], 8.8; 95% confidence interval [CI], 2.5-31.2; p = 0.001) and needle tip placement outside the target lesion (OR, 13.7; 95% CI, 1.4-132.2; p = 0.02) were risk factors for nondiagnostic results. The overall and major complication rates were 51% (46/91) and 12% (11/91), respectively. The presence of honeycombing along the path of the needle (OR, 11.2; 95% CI, 1.4-89.1; p = 0.02) was an independent risk factor for major complications. CT-guided PTNB shows a relatively reasonable accuracy in diagnosing malignancy in patients with IPF. The complication rate may be high, especially when the needle passes through honeycomb lesions. • In patients with idiopathic pulmonary fibrosis (IPF), CT-guided percutaneous transthoracic needle lung biopsy (PTNB) showed a relativelyreasonable accuracy for the diagnosis of malignancy. • Target lesion size ≤ 3 cm and biopsy needle tip placement outside the target lesion were risk factors for nondiagnostic results of CT-guided PTNB. • The complication rate may be high, especially in cases where the biopsy needle passes through honeycomb lesions.

Complication Following CT-guided Transthoracic Lung Biopsy: A Systematic Review and Meta-analysis

Complication Following CT-guided Transthoracic Lung Biopsy: A Systematic Review and Meta-analysis

Cone-Beam CT-Guided Percutaneous Transthoracic Needle Lung Biopsy of Juxtaphrenic Lesions: Diagnostic Accuracy and Complications.

ObjectiveTo investigate the diagnostic accuracy and complications of cone-beam CT-guided percutaneous transthoracic needle biopsy (PTNB) of juxtaphrenic lesions and identify the risk factors for diagnostic failure and complications.Materials and MethodsIn total, 336 PTNB procedures for lung lesions (mean size ± standard deviation [SD], 4.3 ± 2.3 cm) abutting the diaphragm in 326 patients (189 male and 137 female; mean age ± SD, 65.2 ± 11.4 years) performed between January 2010 and December 2014 were included. The accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the PTNB procedures for the diagnosis of malignancy were measured based on the intention-to-diagnose principle. The risk factors for diagnostic failures and complications were evaluated using logistic regression analysis.ResultsThe accuracy, sensitivity, specificity, PPV, and NPV were 92.7% (293/316), 91.3% (219/240), 91.4% (74/81), 96.9% (219/226), and 77.9% (74/95), respectively. There were 23 diagnostic failures (7.3%), and lesion sizes ≤ 2 cm (p = 0.045) were the only significant risk factors for diagnostic failure. Complications occurred in 98 cases (29.2%), including 89 cases of pneumothorax (26.5%) and 7 cases of hemoptysis (2.1%). The multivariable analysis showed that old age (> 65 years) (p = 0.002), lesion size of ≤ 2 cm (p = 0.003), emphysema (p = 0.006), and distance from the pleura to the target lesion (> 2 cm) (p = 0.010) were significant risk factors for complications.ConclusionThe diagnostic accuracy of cone-beam CT-guided PTNB of juxtaphrenic lesions for malignancy was fairly high, and the target lesion size was the only significant predictor of diagnostic failure. Complications of cone-beam CT-guided PTNB of juxtaphrenic lesions occurred at a reasonable rate.

Development of a hemoptysis risk prediction model for patients following CT-guided transthoracic lung biopsy

BackgroundComputed tomography-guided transthoracic needle biopsy (CT-TNB) is a widely used method for diagnosis of lung diseases; however, CT-TNB-induced bleeding is usually unexpected and this complication can be life-threatening. The aim of this study was to develop and validate a predictive model for hemoptysis following CT-TNB.MethodsA total of 436 consecutive patients who underwent CT-TNB from June 2016 to December 2017 at a tertiary hospital in China were divided into derivation (n = 307) and validation (n = 129) cohorts. We used LASSO regression to reduce the data dimension, select variables and determine which predictors were entered into the model. Multivariate logistic regression was used to develop the predictive model. The discrimination capacity of the model was evaluated by the area under the receiver operating characteristic curve (AUROC), the calibration curve was used to test the goodness-of-fit of the model, and decision curve analysis was conducted to assess its clinical utility.ResultsFive predictive factors (diagnosis of the lesion, lesion characteristics, lesion diameter, procedure time, and puncture distance) selected by LASSO regression analysis were applied to construct the predictive model. The AUC was 0.850 (95% confidence interval [CI], 0.808–0.893) in the derivation, and 0.767 (95% CI, 0.684–0.851) in the validation. The model showed good calibration consistency (p > 0.05). Moreover, decision curve analysis indicated its clinical usefulness.ConclusionWe established a predictive model that incorporates lesion features and puncture parameters, which may facilitate the individualized preoperative prediction of hemoptysis following CT-TNB.

Pneumothorax after CT-guided transthoracic lung biopsy: A comparison between immediate and delayed occurrence.

In CT-guided transthoracic lung biopsy (CTLB), pneumothorax can occur as a late complication (delayed pneumothorax). The incidence, risk factors, and clinical significance of delayed pneumothorax are not well known. To compare the risk factors for immediate and delayed pneumothorax after CTLB and to know their clinical significance. Images and medical records of 536 consecutive patients who underwent CTLB were reviewed. All biopsies were performed as inpatient procedures. Follow-up chest radiographs were obtained at least twice at 4 h after procedure and before discharge. Risk factors for immediate and delayed pneumothorax were assessed based on patient-, lesion-, and procedure-related variables. Rates of chest tube insertion were also compared. Pneumothorax developed in 161 patients (30.0%) including 135 (25.2%) immediate and 26 (4.9%) delayed cases. Lesion size was an independent risk factor for both immediate and delayed pneumothorax (OR = 0.813; CI = 0.717-0.922 and OR = 0.610; CI = 0.441-0.844, respectively). While emphysema, lower lobe location, and long intrapulmonary biopsy track were risk factors (OR = 1.981; CI = 1.172-3.344, OR = 3.505; CI = 2.718-5.650, and OR = 1.330; CI = 1.132-1.563, respectively) for immediate pneumothorax, upper lobe location and increased number of pleural punctures were independent risk factors (OR = 5.756; CI = 1.634-20.274 and OR = 3.738; CI = 1.860-7.511, respectively) for delayed pneumothorax. The rate of chest tube insertion was significantly (p < 0.001) higher in delayed pneumothorax. Pneumothorax tends to occur immediately after CTLB in patients with emphysema, lower lobe lesion, and long intrapulmonary biopsy track. Further attention and warnings are needed for those with multiple punctures of small lesions involving upper lobes due to the possibility of delayed development of pneumothorax and higher requirement for chest tube drainage.

DIAGNOSTIC APPROACH OF A YOUNG MALE WITH PLEUROPARENCHYMAL FIBROELASTOSIS

TYPE: Abstract Publication TOPIC: Diffuse Lung Disease PURPOSE: Pleuroparenchymal fibroelastosis (PPFE) is increasingly being recognized as a distinct clinical entity. We present a case of a young male with dyspnea and functional impairing. METHODS: Case report RESULTS: Male, 30 years-old, with progressive dyspnea mMRC 3 and dry cough. Light smoker, 5 pack-years, with familial history of interstitial disease and lung transplant. Chest-CT revealed bilateral subpleural opacities and pleural thickening restricted to the upper lobes, without lymph node enlargement. Functional evaluation showed restrictive ventilatory defect (FVC 37%, FEV1 40,9%, I. Tiff. 93, TLC 44,7%), low DLCO (43,1%) and desaturation to 74% in 6 minute walk test. Normal blood analysis, including autoimmunity and SACE. Bronchoalveolar lavage with macrophage predominance, CD4/CD8 ratio 1,3 and positive Ziehl–Neelsen in citology. Patient was treated with isoniazid, rifampicin, pyrazinamide and ethambutol for 2 months followed by maintenance treatment, with some clinical improvement, but persistence of radiological and functional abnormalities. CT-guided transthoracic lung biopsy (TTLB) was inconclusive due to mostly pleural representation. Iatrogenic pneumothorax occurred with need of drainage. A second TTLB was performed revealing fibrosis and elastosis of lung parenchyma, without granulomas or honeycombing. CONCLUSIONS: The symptoms, radiologic and histologic findings are compatible with PPFE. However, differential diagnosis includes other diseases with upper lobe predominance, like sarcoidosis and tuberculosis. The latter may occur due to increased susceptibility of these patients to opportunistic infections. CLINICAL IMPLICATIONS: To make an accurate diagnosis in diffuse lung diseases a multidisciplinary approach is needed. A continuous update is important to warrant the correct recognition and classification of diseases. DISCLOSURE: No significant relationships. KEYWORDS: Pleuroparenchymal fibroelastosis, Diffuse lung diseases, Multidisciplinar

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?

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