Akciğer içindeki iğne manevrası sayısının ve plevral ponksiyon sayısının, akciğer transtorasik çekirdek iğne biyopsisinin bir komplikasyonu olan pnömotoraks oluşumuna etkisi

Öz

Amaç Bu çalışmada BT eşliğinde transtorasik çekirdek iğne biyopsisinde, iğne manevrası sayısı ve plevral ponksiyon sayısının pnömotoraks üzerine etkisini araştırmak amaçlandı. Yöntem Hastalara uygulanan BT eşliğinde çekirdek iğne biyopsisi kayıtları retrospektif olarak incelendi. Demografik veriler, işlem raporları, patoloji raporları, tomografi görüntüleri, takip muayeneleri ve biyopsiye bağlı komplikasyonlar incelendi. Daha sonra, iğnenin plevraya kaç kez girdiği ve akciğerdeki manevra sayısı listelenmiştir. Plevral ponksiyon sayısı 1 veya ≥2 olarak kaydedildi. İğne manevra sayısı 1, 2 veya ≥3 olarak kaydedildi. Listelenen tüm değişkenler istatistiksel olarak değerlendirildi. Bulgular Toplamda 393 hasta çalışmaya dahil edildi. Pnömotoraks komplikasyonu 87(%22,1) hastada oldu. Pnömotoraksa bağlı toraks tüpü uygulaması 39(%9,9) hastada gerekli oldu. Biyopsi uygulama esnasındaki akciğerlerdeki iğne manevrası sayısının 3+ olduğu durumlarda, pnömotoraks insidansında ve toraks tüpü uygulama gereksiniminde artış saptandı (p=0.001). Lezyon boyutu azaldıkça ve lezyon plevra mesafesi arttıkça iğnenin akciğer içerisindeki manevra sayısı artmıştır (p=0.001, p=0.008). Plevra delinme sayısı ≥2 olan 48 hastada, pnömotoraks ve toraks tüpü uygulama oranları artmıştır (p=0.001, p=0.001). Sonuç BT eşliğinde yapılan pulmoner transtorasik çekirdek iğne biyopsisi uygulamalarında, iğne manevrası sayısı ve plevral ponksiyon sayısı pnömotoraks gelişme riskine katkıda bulunan ana faktörleri oluşturmaktadır.

Anahtar Kelimeler

• pnömotoraks,akciğer kanseri,transtorasik biyopsi,akciğer biyopsisi

The effect of the number of needle maneuver in the lung and the number of pleural punctures on the formation of pneumothorax, a complication of lung transthoracic core needle biopsy

Öz

Aim This study sought to investigate the effect of the needle maneuver count and number of pleural punctures on pneumothorax in CT-guided transthoracic core needle biopsy. Materials and Methods Records of CT-guided core needle biopsy performed on patients were retrospectively reviewed. Demographic data, procedure reports, pathology reports, tomography images, follow-up examinations, and complications due to biopsy were examined. Next, the number of times the needle penetrated the pleura and the number of maneuvers in the lung were listed. The number of pleural punctures was recorded either as 1 or ≥2. The needle maneuver count was recorded either as 1, 2, or ≥3. All listed variables were statistically evaluated. Results A total of 393 patients were included in the study. Complications of pneumothorax occurred in 87 (22.1%) patients. A thorax tube application due to pneumothorax was required in 39 (9.9%) patients. When the needle maneuver count in the lungs during biopsy was greater than 3, the incidence of pneumothorax and the need for a thorax tube application were increased (p = 0.001). As the size of the lesion decreased and the lesion-pleura distance increased, the needle maneuver count in the lung increased (p = 0.001, p = 0.008). Pneumothorax and thorax tube application rates were increased in 48 patients with pleural punctures ≥2 (p = 0.001, p = 0.001). Conclusion In CT-guided pulmonary transthoracic core needle biopsy applications, needle maneuver count and the number of pleural punctures constitute the major factors contributing to the risk of developing pneumothorax.

Anahtar Kelimeler

• pneumothorax,lung cancer,transthoracic biopsy,lung biopsy

Kaynakça

1. Manhire A, Charig M, Clelland C, et al. Guidelines for radiologically guided lung biopsy. Thorax 2003;58(11):920-936. doi: 10.1136/thorax.58.11.920
2. de Margerie-Mellon C, de Bazelaire C, de Kerviler E. Image-guided biopsy in primary lung cancer: Why, when and how. Diagn Interv Imaging. 2016;97:965-972. doi: 10.1016/j.diii.2016.06.016.
3. Li Y, Du Y, Yang HF, et al. Re. CT-guided percutaneous core needle biopsy for small (≤ 20 mm) pulmonary lesions. Clin. Radiol 2013; 68(1): e43-48. doi: 10.1016/j.crad.2012.09.008
4. Gould MK, Donington J, Lynch WR, et al. Evaluation of individuals with pulmonary nodules: When is it lung cancer? Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2013;143:93-120. doi: 10.1378/chest.12-2351
5. Winer-Muram HT. The solitary pulmonary nodule. Radiology 2006;239(1):34-49. doi: 10.1148/radiol.2391050343
6. Heck SL, Blom P, Berstad A. Accuracy and complications in computed tomography fluoroscopy guided needle biopsies of lung masses. Eur Radiol 2006;16(6):1387-1392. doi: 10.1007/s00330-006-0152-2
7. Lucidarme O, Howarth N, Finet JF, Grenier PA. Intrapulmonary lesions: percutaneous automated biopsy with a detachable, 18-gauge, coaxial cutting needle. Radiology 1998;207:759-765.
8. Arakawa H, Nakajima Y, Kurihara Y, Niimi H, Ishikawa T. CT-guided transthoracic needle biopsy: a comparison between automated biopsy gun and fine needle aspiration. Clin Radiol 1996;51(7):503-506. doi: 10.1016/s0009-9260(96)80191-7.

9. Saji H, Nakamura H, Tsuchida T, et al. The incidence and the risk of pneumothorax and chest tube placement after percutaneous CT-guided lung biopsy: the angle of the needle trajectory is a novel predictor. Chest 2002;121:1521-1526.
10. Yeow KM, Su IH, Pan KT, et al. Risk factors of pneumothorax and bleeding: multivariate analysis of 660 CT-guided coaxial cutting needle lung biopsies. Chest 2004;126:748-754.
11. Khan MF, Straub R, Moghaddam SR, et al. Variables affecting the risk of pneumothorax and intrapulmonal hemorrhage in CT-guided transthoracic biopsy. Eur Radiol 2008;18:1356-1363.
12. de Bazelaire C, Coffin A, Cohen-Zarade S, et al. CT-guided biopsies in lung infections in patients with haematological malignancies. Diagn Interv Imaging. 2013;94:202-215. doi: 10.1016/j.diii.2012.12.008.
13. Min L, Xu X, Song Y, et al. Breath-hold after forced expiration before removal of the biopsy needle decreased the rate of pneumothorax in CT-guided transthoracic lung biopsy. Eur J Rad 2013; 82(1):187-190. doi.org/10.1016/j.ejrad.2012.09.013.
14. De Filippo M, Saba L, Silva M, et al. CT-guided biopsy of pulmonary nodules: is pulmonary hemorrhage a complication or an advantage? Diagn Interv Radiol 2014;20(5):421-425. doi: 10.5152/dir.2014.14019.
15. Ocak S, Duplaquet F, Jamart J, et al. Diagnostic accuracy and safety of Ct-guided percutaneous transthoracic needle biopsies: 14-gauge versus 22-gauge needles. J Vasc Interv Radiol 2016;27(5):674-81. doi: 10.1016/j.jvir.2016.01.134.
16. Wu CC, Maher MM, Shepard JO. Complications of CT-guided percutaneous needle biopsy of the chest: Prevention and management. Am J Roentgenol 2011;196:678-682. doi:10.2214/AJR.10.4659.
17. Heerink WJ, de Bock GH, de Jonge GJ, Groen HJM,Vliegenthart R, Oudkerk M. Complication rates of CT-guided transthoracic lung biopsy: meta-analysis. Eur Radiol 2017; 27:138-148. doi:10.1007/s00330-016-4357-8.
18. Alessandro V, Antonio G, Carmine N, et al. Age as a risk factor in the occurrence of pneumothorax after transthoracic fine needle biopsy: Our experience. Int J Surg 2014; 12:29-32.
19. Fior D, Vacirca F, Leni D, et al. Virtual guidance of percutaneous transthoracic needle biopsy with c-arm cone-beam ct: diagnostic accuracy, risk factors and effective radiation dose. Cardiovasc Intervent Radiol 2019;42:712. doi:10.1007/s00270-019-02163-3.
20. Covey AM, Gandhi R, Brody LA, et al. Factors associated with pneumothorax and pneumothorax requiring treatment after percutaneous lung biopsy in 443 consecutive patients. J Vasc Interv Radiol 2004; 15:479-483.
21. Laurent F, Latrabe V, Vergier B, Montaudon M, Vernejoux JM, Dubrez J. CT-Guided CT-guided transthoracic needle biopsy of pulmonary nodules smaller than 20 mm: results with an automated 20-gauge coaxial cutting needle. Clin Radiol 2000;55: 281-287. doi:10.1053/crad.1999.0368.
22. Heyer CM, Reichelt S, Peters SA, Walther JW, Müller KM, Nicolas V. Computed tomography navigated transthoracic core biopsy of pulmonary lesions: which factors affect diagnostic yield and complication rates? Acad Radiol 2008;15:1017-1026.
23. Shiekh Y, Haseeb WA, Feroz I, Shaheen FA, Gojwari TA, Choh NA. Evaluation of various patient-, lesion-, and procedure-related factors on the occurrence of pneumothorax as a complication of CT-guided percutaneous transthoracic needle biopsy. Pol J Radiol 2019;84:73-79. doi:10.5114/pjr.2019.82837.
24. Geraghty PR, Kee ST, McFarlane G, Razavi MK, Sze DY, Dake MD. CT-guided transthoracic needle aspiration biopsy of pulmonary nodules: Needle size and pneumothorax rate. Radiology 2003;229:475-481. doi: 10.1148/radiol.2291020499.
25. Cox JE, Chiles C, McManus CM, Aquino SL, Choplin RH. Transthoracic needle aspiration biopsy: variables that affect risk of pneumothorax. Radiology 1999; 212(1):165-168. doi: 10.1148/radiology.212.1.r99jl33165.
26. Uzun Ç, Akkaya Z, Düşünceli Atman E, et al. Diagnostic accuracy and safety of CT-guided fine needle aspiration biopsy of pulmonary lesions with non-coaxial technique: a single center experience with 442 biopsies. Diagn Interv Radiol 2017;23(2):137-143. doi: 10.5152/dir.2016.16173.