Safely Shortening the Observation Time After CT-Guided Lung Procedures

To determine safety of shortened observation time without follow-up chest x-ray (CXR) after CT-guided transthoracic procedures (lung biopsy or fiducial placement) in patients without immediate postprocedural pneumothorax (PTX).

Consecutive patients that underwent CT-guided procedures between January 5, 2015, and June 19, 2017, were included in this retrospective institutional review board-approved HIPAA-compliant study. Data regarding postprocedural course, complications, and clinical follow-up of the patients were obtained through a review of electronic medical records. Descriptive statistics were used.

There were 441 procedures for 409 patients performed; 82 procedures were excluded because of predefined criteria. In 312 of 336 asymptomatic procedures (92.9%), asymptomatic patients did not undergo CXR after procedure, with 7 of 312 of these patients (2.2%) diagnosed with delayed PTX 2 to 10 days after the procedure. In 24 of 336 procedures (7.1%), asymptomatic patients underwent CXR within 4 hours with no PTX detected, and despite that 1 of 24 of these patients (4.2%) presented with delayed PTX 7 days after procedure. When no immediate postprocedural PTX was present, rate of observation PTX and delayed PTX was 1 of 359 (0.3%) and 8 of 359 (2.2%), respectively. Average duration of monitoring for outpatients (n = 295) was 2.0 hours with median of 1.8 hours. In 23 of 359 (6.4%) procedures, the patient became symptomatic during postprocedural observation with 1 of 23 (4%) developing PTX.

Obtaining routine postprocedural CXRs in asymptomatic patients without immediate postprocedural PTX after CT-guided transthoracic procedures is likely not necessary given the low likelihood of PTX.