Objectives: To evaluate the frequency and severity of the pulmonary parenchymal hemorrhage after coaxial transthoracic needle biopsy of the lung, according to procedural factors not yet described in the literature. This study aimed to determine whether the choice of the coaxial biopsy technology, patient positioning, and the lesion dignity are three new variables influencing the risk of parenchymal hemorrhage after coaxial biopsies of the lung.
Methods: Records from 117 patients who underwent transthoracic needle biopsies of the lung between January 2018 and April 2020 have been retrospectively reviewed. The primary outcome was pulmonary hemorrhage. A grading system has been used to classify pulmonary parenchymal hemorrhage: Grade 0 - Grade 3. Three novel patient, technique, and lesion-related variables were evaluated as predictors of pulmonary hemorrhage: coaxial biopsy technology, patient positioning, and lesion dignity.
Results: Out of the 117 patients, 18 (15.4%) patients with cutting coaxial biopsy technology, versus 29 (24.8%) patients with full core coaxial technology showed significant hemorrhage on the post-biopsy control scans (95% CI 0.06-0.33, p<0.0001).
No significant difference in pulmonary hemorrhage between benign and malignant histological diagnosis (95% CI: 0.84-4.44, p=0.1199) and prone or supine patient positioning (95% CI: 0.57-2.57, p= 0.6232) was found.
Conclusions: The incidence and severity of pulmonary hemorrhage depend on the coaxial biopsy technology used; being higher in patients undergoing a biopsy with full-core technology and lower after the use of cutting technology. No significant correlation between parenchymal pulmonary hemorrhage and patient positioning or lesion dignity was established in this prognostic study.
Lung Biopsy; Pulmonary Hemorrhage; Coaxial Biopsy System; Cutting Technology; Full-Core Technology; Risk Factors
Diagnostic lung biopsies using coaxial biopsy systems have become a standard procedure in most interventional radiology departments and are associated with comparable diagnostic accuracy to other biopsy systems . Lower rates of pneumothoraces and time reduction have been described with coaxial cutting systems .
After pneumothorax, pulmonary hemorrhage is the second most the common complication of needle biopsy of the chest [2,3].
Previous studies have determined subsolid lesions as a risk factor for severe hemoptysis and higher-grade parenchymal hemorrhage [4,5].
Yeow KM, et al. (2004) , has stated that the needle size, number of biopsies, pleural puncture site position after a needle biopsy, location of the lung lesions, patient’s age, and emphysema were not associated with an increased risk of parenchymal hemorrhage. Lesion size, lesion depth and pleural effusion have been described as significantly associated with pulmonary hemorrhage .
Pneumothoraces and parenchymal hemorrhage have furthermore been described to significantly correlate with lesion sizes ≤ 2 cm and lesion depth . Lesion depth ≥ 2.1 cm correlate to an elevated bleeding risk. Lesion size < 4 cm is strongly correlated with a higher occurrence of perifocal hemorrhage .
Considering these variables, the aim of this study was to determine whether the coaxial biopsy technology, patient positioning and lesion dignity are three new risk factors of parenchymal hemorrhage after coaxial biopsies of the lung (Figure 1 to Figure 3).
Regarding pneumothorax, the most common complication after transthoracic lung biopsies, several studies correlated the incidence and severity with patient positioning [6-8]. Other studies correlated inflammatory lesions with higher rates of systemic air embolism [9-11]. The aim of our study was to correlate these variables as potential risk factors for pulmonary parenchymal hemorrhage.