CT characteristics predictive of complications during CT-guided transthoracic biopsies of lung lesions

Abstract

CT-guided transthoracic biopsy is a minimally invasive technique frequently employed for obtaining histopathological diagnoses of lung lesions. While certain complications may arise from this procedure, the low incidence of major complications underscores its safety. This study aims to analyze predictive CT characteristics and the patients' pathological history regarding the development of complications during CT-guided transthoracic biopsies.

A retrospective, observational, cross-sectional, and analytical study was conducted on 43 patients who underwent CT-guided transthoracic biopsies. The study involved evaluating the attenuation, size, location, and distance of the lesion from the pleura. Additionally, the occurrence of pneumothorax and subcutaneous emphysema was assessed using control CT images acquired immediately after the biopsy. Patient demographics, including age, sex, pathological history, and biopsy results, were also collected. This study employed various statistical measures, such as absolute and relative frequencies, means, standard deviations, minimum and maximum values, and associations among variables, to describe the data.

Among the 43 patients studied, 9 (21%) developed pneumothorax. Notably, 4 of these cases had lesions located in direct contact with the pleura (0 mm distance) (p-value: 0.0205; odds ratio [OR]: 5.83, 95% confidence interval [CI]: 1.29-26.49). A statistically significant correlation was observed between the distance of the lesion from the pleura and the occurrence of pneumothorax (p=0.0390). Subcutaneous emphysema was identified in 20 (47%) patients after the CT-guided biopsy, with 13 of these cases occurring in female patients (p-value: 0.0061; OR: 6.14, 95% CI: 1.68-22.49). Other evaluated variables did not exhibit statistically significant associations with the development of pneumothorax or subcutaneous emphysema as complications of the biopsy.

The observed association between the distance of the lesion from the pleura and the occurrence of pneumothorax aligns with findings derived of other studies. Although patient age has been reported as a significant risk factor in complications in prior research, it did not emerge as a significant variable in our study results. Both pneumothorax and subcutaneous emphysema were demonstrated to be frequent complications following CT-guided transthoracic biopsies. In addition to these complications, the procedure proved effective in achieving histopathological diagnoses of lung lesions.