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The yield of immediate post lung biopsy CT in predicting iatrogenic pneumothorax
Rafael Y Brzezinski1,2,3, Ifat Vigiser4, Irina Fomin5
1Department of Internal Medicine "C", "D" and "E", Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Insights
Immediate post-procedure CT scans cannot replace chest X-rays for detecting pneumothorax after lung biopsies. While CT is useful, it misses some cases, highlighting the continued need for routine X-rays to monitor for complications.
Area of Science:
- Pulmonology
- Radiology
- Interventional Procedures
Background:
- Pneumothorax (PNX) is a common complication of percutaneous lung biopsy.
- Immediate post-procedure CT scans (ICT) are used in some centers to detect PNX.
- The diagnostic utility of ICT versus routine follow-up chest X-ray (CXR) needs further evaluation.
Purpose of the Study:
- To assess if an immediate post-procedure CT scan can replace routine follow-up CXR for detecting procedure-related pneumothorax.
- To evaluate the diagnostic yield and concordance of ICT and CXR in identifying PNX post-biopsy.
Main Methods:
- Retrospective analysis of 453 patients undergoing percutaneous lung biopsy.
- Comparison of findings from immediate post-procedure CT scans (ICT) and 2-hour post-procedure chest X-rays (CXR).
- Multivariate analysis to identify PNX risk factors and assess ICT-CXR concordance.
Main Results:
- 19% of patients developed pneumothorax (PNX) detected on 2-hour CXR.
- ICT detected 80.5% of PNX cases, but had a negative predictive value of 94%.
- 17 patients (6%) with negative ICT developed PNX on CXR; bleeding at the puncture site was a negative predictor (OR=0.4).
Conclusions:
- Immediate post-procedure CT scans are insufficient to replace routine follow-up CXR for detecting iatrogenic PNX.
- The presence of bleeding in the needle tract on ICT may indicate a lower risk of PNX.
- Continued use of routine CXR is recommended for comprehensive PNX monitoring after percutaneous lung biopsy.
Background:
The most prevalent complication of percutaneous lung biopsy is pneumothorax (PNX). A routine immediate post-procedure CT scan (ICT) to spot PNX is done in many centers. However, the diagnostic yield of this practice has not been studied broadly. We sought to evaluate whether an ICT could replace the routine follow-up chest X-ray (CXR) in detecting procedure related PNX.
Methods:
We examined case-records of 453 patients who underwent lung biopsy at our medical center. We analyzed findings from CXR performed 2-h after biopsy and from CT images at the site of biopsy acquired immediately after the procedure (ICT). Multivariate analysis was used to identify the risk factors for PNX, and we examined the concordance between ICT and CXR-2-h post-procedure.
Results:
A total of 87 patients (19%) were diagnosed with PNX on CXR-2-h post-procedure. ICT detected 80.5% of diagnosed PNX (p < 0.01). However, ICT demonstrated a negative predictive value of only 94%, meaning 17 patients (6%) with a negative ICT did eventually develop PNX seen on CXR. Furthermore, bleeding surrounding the puncture area spotted on ICT negatively predicted the development of PNX (OR = 0.4 95% CI; 0.2-0.7).
Conclusions:
We conclude that a CT scan performed immediately after percutaneous lung biopsy cannot replace the routine follow-up CXR in predicting iatrogenic PNX. Bleeding in the needle's tract may lower the risk for procedure-related PNX.
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