Evaluation of pneumothorax and pulmonaryhemorrage risk factors in CT- guidedpercutaneous transtoracic lung biopies

Objective: Lung cancer is among the deadliest and most common cancer types. Diagnosis of newly defined lung lesions requires tissue sampling and histopathological evaluation. CT-guided percutaneous transthoracic biopsy (PTB) method is frequently used to provide tissue samples. Even though it is a minimally invasive method with high diagnostic success, complications such as pneumothorax and parenchymal hemorrhage can be seen. There are many publications in the literature evaluating PTB complications, risk factors for pneumothorax and parenchymal hemorrhage due to PTB. However, there was no consensus on the results. In addition, to the best of our knowledge, there are no publications in the literature examining the risk factors for pneumothorax and/or parenchymal hemorrhage. In our study, it was aimed to separately evaluate the risk factors of pneumothorax, parenchymal hemorrhage and pneumothorax and/or parenchymal hemorrhage secondary to PTB procedure under CT guidance. Materials and Methods: This retrospective study includes 200 PTB procedures performed in the interventional radiology department of our institution under the guidance of CT. The included procedures were evaluated in terms of age, gender, lesion-related features, lung structure-related features, procedure technique-related parameters, and histopathological results. Results were analyzed in terms of intergroup relations and independent risk factors were evaluated through logistic regression analysis by using IBM SPSS 20 and MedCalc v20 statistical programs. Findings: In our study, procedure time (body-needle time) >3 minutes, presence of multiple pleural passage and presence of fissure passage were determined as independent risk factors for pneumothorax complication (p= 0.036; p<0.001; p=0.001 respectively). Independent risk factors for parenchymal hemorrhage secondary to the procedure are; age >66 years, lesion diameter ≤36 mm, distance between lesion and pleura on the needle tract >1 mm, and procedure time (body-needle time) >2.5 minutes (p<0.001; p<0.001; p<0.001; p=0.002, respectively). Finally, analysis of risk factors for pneumothorax and/or parenchymal hemorrhage revealed that; male gender, tumor diameter of ≤55 mm, distance between lesion and pleura on the needle tract >4 mm, procedure time of >2.5 minutes (body-needle time), and multiple pleural passage are independent risk factors (p=0.039; p<0.001; p=0.001; p=0.034; p=0.021, respectively). Results: According to the findings of our study; age, gender, lesion diameter, presence of multiple pleural passage, presence of fissure passage, distance between lesion and pleura in the needle tract, duration of the procedure were determined as risk factors that can be used to predict complications secondary to PTB procedure. Complication risk was found to be higher in elderly male patients and in procedures performed for small lesions. We believe that it is important to make the necessary treatment and follow-up preparations in high-risk procedures. We are of the opinion that the risk of complications can be greatly reduced if the procedure is safely performed in the shortest time possible, with a single pleural passage, without fissure passage and by choosing the shortest possible intraparenchymal distance for the needle tract. We think that supporting the current results with longer-term studies with larger samples and developing scoring methods will be beneficial in clinical use. Keywords: CT guided lung biopsy, percutaneous transthoracic biopsy, tru-cut biopsy, fine needle aspiration biopsy, complications, pneumothorax, parenchymal hemorrhage