Complications in CT-Guided, Semi-Automatic Coaxial Core Biopsy of Potentially Malignant Pulmonary Lesions

Abstract

Purpose: Histological verification of pulmonary lesions is important to ensure correct treatment. Computed tomographic (CT) transthoracic core biopsy is a well-established procedure for this. Comparison of available studies is difficult though, as technical and patient characteristics vary. Using a standardized biopsy technique, we evaluated our results for CT-guided coaxial core biopsy in a semi-automatic technique.

Materials and Methods: Within 2 years, 664 consecutive transpulmonary biopsies were analyzed retrospectively. All interventions were performed using a 17/18G semi-automatic core biopsy system (4 to 8 specimens). The incidence of complications and technical and patient-dependent risk factors were evaluated.

Results: Comparing the histology with the final diagnosis, the sensitivity was 96.3 %, and the specificity was 100 %. 24 procedures were not diagnostic. In all others immunohistological staining was possible. The main complication was pneumothorax (PT, 21.7 %), with chest tube insertion in 6 % of the procedures (n = 40). Bleeding without therapeutic consequences was seen in 43 patients. There was no patient mortality. The rate of PT with chest tube insertion was 9.6 % in emphysema patients and 2.8 % without emphysema (p = 0.001). Smokers with emphysema had a 5 times higher risk of developing PT (p = 0.001). Correlation of tumor size or biopsy angle and the risk of PT was not significant. The risk of developing a PT was associated with an increasing intrapulmonary depth of the lesion (p = 0.001).

Conclusion: CT-guided, semiautomatic coaxial core biopsy of the lung is a safe diagnostic procedure. The rate of major complications is low, and the sensitivity and specificity of the procedure are high. Smokers with emphysema are at a significantly higher risk of developing pneumothorax and should be monitored accordingly.

Key points:

• Using an 18G core biopsy system with 6 specimens will allow immunohistological staining with high sensitivity and specificity.

• Smokers with emphysema are at a significantly higher risk of developing a pneumothorax.

Citation Format:

• Schulze R, Seebacher G, Enderes B. et al. Complications in CT-Guided, Semi-Automatic Coaxial Core Biopsy of Potentially Malignant Pulmonary Lesions. Fortschr Röntgenstr 2015; 187: 697 – 702

Zusammenfassung

Ziel: Die histologische Sicherung eines malignomsuspekten Lungenherdbefundes ist die Grundvoraussetzung für eine adäquate Behandlung. Die computertomografische (CT), transthorakale Histologiesicherung ist dabei ein etabliertes Verfahren. Die Vergleichbarkeit der vorhandenen Studien ist aber schwierig, da sowohl technische Einflüsse als auch die Patientencharakteristika stark variieren. Unsere Ergebnisse nach CT-gesteuerter, koaxialer Stanzbiopsie in halbautomatischer Technik werden präsentiert.

Material und Methoden: 664 konsekutive Interventionen in einem 2-Jahres-Zeitraum wurden retrospektiv analysiert. Alle Eingriffe wurden mit einer halbautomatischen 17/18G Koaxialnadel durchgeführt, dabei 4 – 8 Proben entnommen. Komplikationsraten und der Einfluss technischer wie patientenabhängiger Risikofaktoren wurden analysiert.

Ergebnisse: Bei Vergleich der histologischen Ergebnisse mit der endgültigen Diagnose lag die Sensitivität bei 96,3 %, die Spezifität bei 100 %. 24 Untersuchungen waren nicht diagnostisch. In allen anderen Fällen wurde ausreichend Gewebe für eine immunhistologische Differenzierung gewonnen. Bei 21,7 % der Patienten (n = 144) zeigte sich ein Pneumothorax (PT), der in 6 % drainiert werden musste (n = 40). Bei 43 Patienten zeigte sich eine nicht interventionsbedürftige, selbstlimitierende Blutung. Die Letalität lag bei 0 %. Die drainagepflichtige PT-Rate bei Emphysempatienten betrug 9,6 %, ohne Empatienten 2,8 % (p = 0,001). Die PT-Rate bei Rauchern mit Emphysem war 5fach erhöht (p = 0,001). Punktionswinkel und die Größe des Lungenherdes zeigten keine Korrelation mit der PT Inzidenz. Das PT-Risiko korrelierte mit zunehmender Länge der intrapulmonalen Punktionsstrecke (p = 0,001).

Schlussfolgerung: Die CT-gesteuerte, koaxiale Punktion von Lungenherden in halbautomatischer Technik ist ein sicheres diagnostisches Verfahren. Die Rate an therapierelevanten Komplikationen ist niedrig, die Sensitivität und Spezifität hoch. Patienten mit Emphysem und Raucheranamnese haben ein deutlich erhöhtes Pneumothoraxrisiko und sollten entsprechend überwacht werden.

Key words

thorax - percutaneous - tissue characterization - CT - biopsy

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