Computed tomography-guided lung biopsy with the patient in lateral decubitus position and the biopsy side down: effect on pneumothorax rate and clinical significance
Journal Title: Hellenic Journal of Radiology - Year 2017, Vol 2, Issue 3
Abstract
Purpose: The purpose of our study is to assess the effect of patient positioning (prone or supine versus lateral decubitus position) upon the rate of pneumothorax, during computed tomography (CT)–guided trans-thoracic needle biopsy of pulmonary lesions. Material and Methods: We retrospectively reviewed data from CT-guided lung biopsies (249 patients) performed in our department during the last four years. 186 biopsies were performed with the patient on prone or supine position (Group A) and 63 were performed with the patient placed on lateral decubitus position with the biopsy-side down (Group B). Statistical analysis was performed between the two groups for pneumothorax, including patient demographic characteristics, lesion characteristics, and biopsy technique. We also compared the results of biopsies performed by the same interventional radiologist between groups. Results: An increased number of pneumothorax was noted in Group A [29 (15.6%)] compared to Group B [1 (1.6%) p=0.003]. There was also an increased number of drainage catheter insertions in Group A compared to Group B [11 (5.9%) versus 0 (0%), respectively, p=0.048]. Higher rates of pneumothorax (14.7%) and pneumothorax requiring treatment (6.7%) were also noticed in biopsies of group A performed by the same interventional radiologist who performed biopsies in group B, compared to biopsies in contralateral position, and these differences were statistically significant (p=0.007 and p=0.037).Lesion size and emphysema along the needle track were independent risk factors for pneumothorax in group A. Emphysema along the needle track was an independent predictor for insertion of a drainage catheter in Group A. No independent predictor was identified for pneumothorax or insertion of a drainage catheter in Group B. Conclusions: Performing percutaneous CT-guided trans-thoracic lung biopsy with the patient placed on lateral decubitus position with the biopsy-side down reduces the rate of pneumothorax and pneumothorax necessitating a drainage catheter. Application of this technique attenuates the influence of traditional risk factors for pneumothorax.
Authors and Affiliations
Dimitrios Filippiadis, Georgios Velonakis, Alexis Kelekis, Nikolaos Kelekis
Keywords
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