Effect of Rapid Rollover on Pneumothorax Rate After Percutaneous CT-Guided Lung Biopsy: A Multisite Randomized...

To evaluate whether the rapid rollover technique reduces new or enlarging pneumothorax after anterior or lateral approach CT-guided lung biopsy.

A prospective, single-institution, multisite, RCT was undertaken after institutional review board approval. Patients with target lesions most amenable to the anterior/lateral approach were considered. Patients with extrapulmonary nodules, intraprocedural chest tube, or conditions that preclude safe repositioning were excluded. The primary outcome was new/enlarging pneumothorax on postbiopsy radiographs. Intention-to-treat (ITT) and per-protocol (PP) analyses were performed. Secondary outcomes, including chest tube insertion rate and patient discomfort, were also analyzed.

A total of 59 patients were recruited, with 28 randomized to the intervention arm and 31 to the control arm, without significant differences in patient demographics and risk factors. There were 8 cases or 13.6% of new/enlarging pneumothorax, 7 from the control arm and 1 from the intervention. One patient who developed pneumothorax in the intervention arm did not complete the maneuver. The difference in rates of new/enlarging pneumothorax was significant by both ITT and PP analyses (P=0.03 and 0.009). Only 2 patients required chest tube insertion, 1 in the control group and 1 who crossed over to the control group. Multivariate analysis was performed in the ITT analysis, with intervention as an independent significant factor (P=0.0463). There were no significant differences in terms of postbiopsy discomfort.

This randomized controlled trial showed that, without an increase in patient discomfort, the rapid rollover technique reduced the risk of new or enlarging pneumothorax after CT-guided lung biopsy via an anterior/lateral approach.

Level I-randomized controlled trial.