CT-guided needle biopsy of lung lesions: A survey of severe complication based on 9783 biopsies in Japan

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Abstract

Purpose

The aim of our study was to update the rate of severe complications following CT-guided needle biopsy in Japan via a mailed survey.

Materials and methods

Postal questionnaires regarding CT-guided needle biopsy were sent out to multiple hospitals in Japan. The questions regarded: the total number and duration of CT-guided lung biopsies performed at each hospital, and the complication rates and numbers of pneumothorax, hemothorax, air embolism, tumor seeding, tension pneumothorax and other rare complications. Each severe complication was followed with additional questions.

Results

Data from 9783 biopsies was collected from 124 centers. Pneumothorax was the most common complication, and occurred in 2412 (35%) of 6881 cases. A total of 39 (35%) hospitals reported 74 (0.75%) cases with severe complications. There were six cases (0.061%) with air embolism, six cases (0.061%) with tumor seeding at the site of the biopsy route, 10 cases (0.10%) with tension pneumothorax, six cases (0.061%) with severe pulmonary hemorrhage or hemoptysis, nine cases (0.092%) with hemothorax, and 27 cases (0.26%) with others, including heart arrest, shock, and respiratory arrest. From a total of 62 patients with severe complications, 54 patients (0.55%) recovered without sequela, however one patient (0.01%) recovered with hemiplegia due to cerebral infarction, and the remaining seven patients (0.07%) died.

Conclusions

This is the first national study documenting severe complications with respect to CT-guided needle biopsy in Japan. The complication rate in Japan is comparable to internationally published figures. We believe this data will improve both clinicians as well as patients understanding of the risk versus benefit of CT-guided needle biopsy, resulting better decisions.

Introduction

Transthoracic needle biopsy is a common procedure used mainly to elucidate the nature of pulmonary nodules [1], [2]. CT has rapidly become the guidance modality of choice for performing transthoracic needle biopsy due to technical advances in CT and its better detection of pulmonary lesions, which sometimes cannot be identified on chest radiograph [3].

CT-guided needle biopsy is generally regarded as a safe procedure, although pneumothorax and other rare complications can sometimes occur [4]. There have been occasional reports of deaths due to severe complications, such as, air embolism following lung biopsy [5]. Fortunately, these complications are generally very rare; previously published data shows wide variations in complication rates, making them difficult to generalize [5], [6], [7], [8].

The aim of our study was to update the rate of severe complications following CT-guided needle biopsy in Japan via a mailed survey.

Section snippets

Materials and methods

Postal questionnaires regarding CT-guided needle biopsy were sent out to named radiologists at 101 university hospitals and cancer centers in Japan in August 2001. The radiologists at these hospitals were asked to pass duplications of the questions to other associate hospitals. The questions required information regarding: the total number and duration of CT-guided lung biopsies performed at each hospital, and the complication rates, numbers of pneumothorax, hemothorax, air embolism, tumor

Results

A total of 9783 biopsy data were collected from 124 centers. The average number of biopsies performed per center was 79 cases, and that per center per year was 21 cases. The number of institutions in which hyperbaric oxygen recompression can be performed was 41 of 114 (37%) hospitals. Patients were kept on peripheral intravenous drip infusion in 86 of 92 (93%) hospitals, automatic sphygmomanometer in 38 of 92 (41%) hospitals, pulse oximetry in 32 of 92 (35%) hospitals, and electrocardiography

Discussion

Recently, many small pulmonary lesions, which cannot be detected on chest radiograph, have been easily visualized by CT examination in daily clinical work. These lesions are usually followed with CT, or in some cases these are biopsies using CT-guided technique. CT-guided needle biopsy is a widely accepted technique and is one of the principal methods for evaluating a pulmonary lesion [9]. Although it is not rare to have minor complications due to CT-guided needle biopsy, such as, a small

Acknowledgement

The authors, members of the Japanese lung biopsy conference, dedicate this manuscript to Dr. Junpei Ikezoe, originator of this conference. We are also grateful to those specialists who completed the questionnaire. The authors thank Dr. Javzandulam Natsag for his assistance with manuscript editing.

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