Preventive tract embolization with gelatin sponge slurry is safe and considerably reduces pneumothorax after CT-guided lung biopsy with use of large 16–18 coaxial needles

Objective: To evaluate the clinical impact of the tract embolization technique using gelatin sponge slurry after percutaneous CT-guided lung biopsy. Methods: We retrospectively compared coaxial needle CT-guided lung biopsies performed without embolization (100 patients) and with the tract embolization technique using a mixture of iodine and gelatin sponge slurry (105 patients) between June 2012 and July 2020. Uni- and multivariate analyses were performed between groups to determine risk factors of pneumothorax. Results: Patients with gelatin sponge slurry tract embolization had statistically lower rates of pneumothorax ((17.1% vs 39%, p < 0.001). In univariate analysis, tract embolization (OR = 0.32, CI = 0.17–0.61 p<0.001) and nodule size >2 cm (OR = 0.33 CI = 0.14–0.8 p = 0.013) had a protective effect on pneumothorax. The puncture path lengths > 2–20 mm and >20 mm were risk factors for pneumothorax (OR = 3.35 IC = 1.44–8.21 p = 0.006 and OR = 4.36 CI = 1.98–10.29 p<0.001, respectively). In multivariate regression analysis, tract embolization had a protective effect of pneumothorax (OR = 0.25, CI = 0.12–0.51, p < 0.001). The puncture path lengths > 2–20 mm and >20 mm were risk factors for pneumothorax (p = 0.030 and p = 0.002, respectively). Conclusions: The tract embolization technique using iodinated gelatin sponge slurry is safe and considerably reduces pneumothorax after percutaneous CT-guided lung biopsy. Our results suggest that it could be use in clinical routine. Advances in knowledge: The systemic use of gelatin sponge slurry is safe and reduces considerably the rate of pneumothorax upon needle removal when CT-guided core biopsies are performed using large 16–18G coaxial needles.

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C-Arm Cone-Beam CT Virtual Navigation Versus Conventional CT Guidance in the Transthoracic Lung Biopsy: A Case-Control Study

Diagnostics ◽

10.3390/diagnostics12010115 ◽

2022 ◽

Vol 12 (1) ◽

pp. 115

Author(s):

Lian Yang ◽

Yue Wang ◽

Lin Li ◽

Dehan Liu ◽

Xin Wu ◽

...

Keyword(s):

Risk Factors ◽

Lung Biopsy ◽

Cone Beam ◽

Ct Guidance ◽

Complication Rates ◽

Virtual Navigation ◽

Ct Guided ◽

Significant Difference ◽

Lung Biopsies ◽

Conventional Ct

C-arm cone-beam computed tomography (CBCT) virtual navigation-guided lung biopsy has been developed in the last decade as an alternative to conventional CT-guided lung biopsy. This study aims to compare the biopsy accuracy and safety between these two techniques and explores the risk factors of biopsy-related complications. A total of 217 consecutive patients undergoing conventional CT- or C-arm CBCT virtual navigation-guided lung biopsy from 1 June 2018 to 31 December 2019 in this single-center were retrospectively reviewed. Multiple factors (e.g., prior emphysema, lesion size, etc.) were compared between two biopsy techniques. The risk factors of complications were explored by using logistic regression. The patients’ median age and male-to-female ratio were 63 years and 2.1:1, respectively. Eighty-two (82) patients (37.8%) underwent conventional CT-guided biopsies, and the other 135 patients (62.2%) C-arm CBCT virtual navigation-guided biopsies. Compared with patients undergoing C-arm CBCT virtual navigation-guided lung biopsies, patients undergoing conventional CT-guided lung biopsies showed higher needle repositioning rate, longer operation time, and higher effective dose of X-ray (52.4% vs. 6.7%, 25 min vs. 15 min, and 13.4 mSv vs. 7.6 mSv, respectively; p < 0.001, each). In total, the accurate biopsy was achieved in 215 of 217 patients (99.1%), without a significant difference between the two biopsy techniques (p = 1.000). The overall complication rates, including pneumothorax and pulmonary hemorrhage/hemoptysis, are 26.3% (57/217), with most minor complications (56/57, 98.2%). The needle repositioning was the only independent risk factor of complications with an odds ratio of 6.169 (p < 0.001). In conclusion, the C-arm CBCT virtual navigation is better in percutaneous lung biopsy than conventional CT guidance, facilitating needle positioning and reducing radiation exposure. Needle repositioning should be avoided because it brings about more biopsy-related complications.

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Prediction of Outcome for Transabdominal Cerclage in Women with Cervical Insufficiency

BioMed Research International ◽

10.1155/2015/985764 ◽

2015 ◽

Vol 2015 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Ji Eun Song ◽

Keun Young Lee ◽

Ga Hyun Son

Keyword(s):

Risk Factors ◽

Multivariate Analysis ◽

Cohort Study ◽

Pregnancy Outcomes ◽

Retrospective Cohort ◽

Multivariate Analyses ◽

Univariate Analysis ◽

Cervical Length ◽

Cervical Insufficiency ◽

Prediction Of Outcome

We investigated pregnancy outcome following transabdominal cerclage (TAC) in women with cervical insufficiency (CI) and explored parameters for predicting pregnancy outcomes following TAC. In this retrospective cohort study, we included 161 women with TAC. We considered demographic, obstetric, and gynecologic histories, pre- and postoperative cervical length (CL), and CL at 20–24 weeks as parameters for predicting outcomes following TAC. Univariate and multivariate analyses were used to identify risk factors for predicting delivery before 34 weeks after TAC. 182 pregnancies occurred after TAC, and 290 pregnancies prior to TAC were identified. The rate of delivery <34 weeks significantly decreased following TAC (5% versus 82%,P<0.001). Univariate analysis demonstrated that a short CL (<25 mm) at 20–24 weeks and adenomyosis were associated with delivery at <34 weeks’ gestation following TAC (P=0.015andP=0.005, resp.). However, multivariate analysis demonstrated that only a short CL (<25 mm) at 20–24 weeks was a significant predictor (P=0.005). TAC is an efficacious procedure that prolongs pregnancy in women with CI. A short CL at 20–24 weeks may predict the delivery at <34 weeks’ gestation following TAC.

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Patient-Related Risk Factors Associated With Surgical Site Complications After Elective Hand Surgery

Hand ◽

10.1177/1558944720944260 ◽

2020 ◽

pp. 155894472094426

Author(s):

Tyler Youngman ◽

Michael Del Core ◽

Timothy Benage ◽

Daniel Koehler ◽

Douglas Sammer ◽

...

Keyword(s):

Risk Factors ◽

Regression Analysis ◽

Surgical Complications ◽

Multivariate Regression ◽

Univariate Analysis ◽

Hand Surgery ◽

Multivariate Regression Analysis ◽

Class Iii ◽

Factors Associated ◽

Surgical Site Complications

Background: The purpose of this study was to identify independent risk factors associated with an increased rate of surgical site complications after elective hand surgery. Methods: This study is a retrospective review of all patients who underwent elective hand, wrist, forearm, and elbow surgery over a 10-year period at a single institution. Electronic medical records were reviewed, and information regarding patient demographics, past medical and social history, perioperative laboratory values, procedures performed, and surgical complications was collected. Surgical site complications included surgical site infections, seromas or hematomas, and delayed wound healing or wound dehiscence. A univariate analysis was then performed to identify potential risk factors, which were then included in a multivariate regression analysis. Results: A total of 3261 patients who underwent elective hand surgery and met the above inclusion and exclusion criteria were included in this study. The mean age was 57 years, with 65% female and 35% male patients. The overall surgical complication rate was 2.2%. Univariate analysis of patient factors identified male sex; number of procedures >1; history of drug, alcohol, or smoking use; American Society of Anesthesiologists (ASA) class III and IV; and serum albumin <3.5 mg/dL to be significantly associated with complications. However, multivariate regression analysis identified that only ASA class III and IV (odds ratio = 3.27) was significantly associated with surgical complications. Conclusions: Patients classified as ASA class III or IV were identified to be at a significantly increased risk of complications following elective hand surgery. Health factors which triage patients into these 2 groups may represent potentially modifiable factors to mitigate perioperative risk in the elective hand surgery population.

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Pneumothorax rates in CT-Guided lung biopsies: a comprehensive systematic review and meta-analysis of risk factors

British Journal of Radiology ◽

10.1259/bjr.20190866 ◽

2020 ◽

Vol 93 (1108) ◽

pp. 20190866 ◽

Cited By ~ 9

Author(s):

Ya Ruth Huo ◽

Michael Vinchill Chan ◽

Al-Rahim Habib ◽

Isaac Lui ◽

Lloyd Ridley

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Lung Biopsy ◽

Tissue Sample ◽

Meta Analysis ◽

Lateral Decubitus Position ◽

Chest Drain ◽

Puncture Site ◽

Ct Guided ◽

Lateral Decubitus

Objective: This systematic review and meta-analysis investigated risk factors for pneumothorax following CT-guided percutaneous transthoracic lung biopsy. Methods: A systematic search of nine literature databases between inception to September 2019 for eligible studies was performed. Results: 36 articles were included with 23,104 patients. The overall pooled incidence for pneumothorax was 25.9% and chest drain insertion was 6.9%. Pneumothorax risk was significantly reduced in the lateral decubitus position where the biopsied lung was dependent compared to a prone or supine position [odds ratio (OR):3.15]. In contrast, pneumothorax rates were significantly increased in the lateral decubitus position where the biopsied lung was non-dependent compared to supine (OR:2.28) or prone position (OR:3.20). Other risk factors for pneumothorax included puncture site up compared to down through a purpose-built biopsy window in the CT table (OR:4.79), larger calibre guide/needles (≤18G vs >18G: OR 1.55), fissure crossed (OR:3.75), bulla crossed (OR:6.13), multiple pleural punctures (>1 vs 1: OR:2.43), multiple non-coaxial tissue sample (>1 vs 1: OR 1.99), emphysematous lungs (OR:3.33), smaller lesions (<4 cm vs 4 cm: OR:2.09), lesions without pleural contact (OR:1.73) and deeper lesions (≥3 cm vs <3cm: OR:2.38). Conclusion: This meta-analysis quantifies factors that alter pneumothorax rates, particularly with patient positioning, when planning and performing a CT-guided lung biopsy to reduce pneumothorax rates. Advances in knowledge: Positioning patients in lateral decubitus with the biopsied lung dependent, puncture site down with a biopsy window in the CT table, using smaller calibre needles and using coaxial technique if multiple samples are needed are associated with a reduced incidence of pneumothorax.

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Diagnostic yield of CT-guided lung biopsies: how can we limit negative sampling?

British Journal of Radiology ◽

10.1259/bjr.20210434 ◽

2021 ◽

Author(s):

Marcello Andrea Tipaldi ◽

Edoardo Ronconi ◽

Miltiadis E Krokidis ◽

Aleksejs Zolovkins ◽

Gianluigi Orgera ◽

...

Keyword(s):

Multivariate Analysis ◽

Lung Biopsy ◽

Diagnostic Yield ◽

Imaging Features ◽

Technical Success ◽

Ct Guided ◽

Fdg Uptake ◽

Increased Risk ◽

Ct Guided Biopsy ◽

Lung Biopsies

Objectives: To investigate whether lesion imaging features may condition the outcome of CT-guided Lung Biopsy (CTLB) and to develop a scoring system of biopsy outcome prediction. Methods: This is a single center retrospective study on 319 CTLBs that were performed in 319 patients (167 males/ 152 females, mean age 68 ± 12.2). Uni- and multivariate analysis were performed aiming to assess the imaging features that are likely to be corelated to a negative biopsy outcome and patients were stratified in groups accordingly. Results: Technical success was 100%. 78% of the biopsies (250/319) led to a concrete histology report (218 malignant/ 32 benign). The remaining lesions led to concrete histology at a second attempt that occurred on a later time. Multivariate analysis revealed increased risk of inconclusive result for nodules with low FDG uptake (OR = 2.64, 95% CI 1.4–4.97; p = 0.003), for nodules with diameter smaller than 18 mm (OR = 2.03, 95% CI 1.14–3.62; p = 0.017) and for nodules that are located in one of the lung bases (OR = 1.96, 95% CI 1.06–3.62; p = 0.033). Three different groups of patients were identified accordingly with low (<30%), medium (30–50%) and high (>50%) probability of obtaining an inconclusive biopsy sample. Conclusions: This study confirms that percutaneous CT guided biopsy in nodules that are either small in diameter or present low PET-FDG uptake or are in one of the lung bases may lead to inconclusive histology. This information should be factored when planning percutaneous biopsies of such nodules in terms of patient informed consent and biopsy strategy. Advances in knowledge: Inconclusive histology after lung biopsy may be subject to factors irrelevant to technical success. Lung biopsy histology outcomes may be predicted and avoided after adequate planning

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Novel Risk Factors of Pulmonary Hemorrhage Complicating CT-Guided Lung Biopsy in Coaxial Technique

10.47275/0032-745x-324 ◽

2021 ◽

Vol 107 (3) ◽

Author(s):

Schroeder C ◽

Loebelenz LI ◽

Noeldge G ◽

Kim SY ◽

Heverhagen JT ◽

...

Keyword(s):

Risk Factors ◽

Lung Biopsy ◽

Pulmonary Hemorrhage ◽

Ct Guided ◽

Novel Risk Factors

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Risk Factors for Systemic Air Embolism as a Complication of Percutaneous CT-guided Lung Biopsy: Multicenter Case-control Study

CardioVascular and Interventional Radiology ◽

10.1007/s00270-013-0808-7 ◽

2013 ◽

Vol 37 (5) ◽

pp. 1312-1320 ◽

Cited By ~ 27

Author(s):

Hiroaki Ishii ◽

Takao Hiraki ◽

Hideo Gobara ◽

Hiroyasu Fujiwara ◽

Hidefumi Mimura ◽

...

Keyword(s):

Risk Factors ◽

Lung Biopsy ◽

Case Control Study ◽

Air Embolism ◽

Case Control ◽

Ct Guided ◽

Systemic Air Embolism ◽

Control Study

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CT-guided Transthoracic Lung Biopsy: Risk Factors For Pneumothorax

10.1164/ajrccm-conference.2010.181.1_meetingabstracts.a5174 ◽

2010 ◽

Author(s):

Chih-Hsin Lee ◽

Yao-Kuang Wu ◽

Hsu-Chao Chang ◽

Chou-Chin Lan ◽

Jann-Yuan Wang ◽

...

Keyword(s):

Risk Factors ◽

Lung Biopsy ◽

Ct Guided

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Feasibility and outcome of CT-guided lung biopsy in patients with hematological diseases and suspected fungal pneumonia

The Journal of Infection in Developing Countries ◽

10.3855/jidc.2823 ◽

2013 ◽

Vol 7 (10) ◽

pp. 748-752 ◽

Cited By ~ 8

Author(s):

Sanjeev Kumar Sharma ◽

Suman Kumar ◽

Avinash Kumar Singh ◽

Tulika Seth ◽

Pravas Mishra ◽

...

Keyword(s):

Ct Scan ◽

Lung Biopsy ◽

Needle Aspiration ◽

Definitive Diagnosis ◽

Aspiration Cytology ◽

Ct Guided ◽

Fine Needle ◽

Hematological Diseases ◽

Needle Aspiration Cytology ◽

Lung Biopsies

Introduction: Fungal pneumonia is a major cause of morbidity and mortality in immunocompromised patients with hematological diseases. This study is aimed to evaluate the feasibility and outcome of computed tomography (CT) guided lung biopsy or fine needle aspiration cytology (FNAC) in the diagnosis of fungal pneumonia in patients with hematological diseases. Methodology: Seven hundred and seventy six consecutive patients with febrile neutropenia were evaluated prospectively over the period of three years. Patients with suspected fungal pneumonia, based on typical CT scan findings, were considered for lung biopsy. Results: Of the 776 patients evaluated for fever, 235 (30.3%) showed CT scan findings consistent with fungal pneumonia. Of the 235 patients, CT-guided lung biopsy/FNAC was recommended for 178 patients but could be performed in only 34 (19.1%) patients. Fungal pneumonia was proven in 15 (44%) out of 34 patients (aspergillus in 12; mucormycosis in 3 patients). Lung biopsies could not be performed for a number of reasons. These included thrombocytopenia, nodules being too small, infection improving with empiric treatment and patient recovering clinically, and the patient being too sick to undergo intervention. The median absolute neutrophil count (ANC) of patients at the time of lung biopsy was 0.41x109/l in patients whose lung biopsy/FNAC showed fungal pneumonia, compared to 2.10x109/l in patients whose biopsy/FNAC showed necrotizing pneumonitis. Conclusion: CT-guided lung biopsy/FNAC can allow the definitive diagnosis of fungal pneumonia in selected patients with various hematological diseases and should be attempted whenever clinically indicated and radiologically feasible.

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