Risk factors for pneumothorax and bleeding after CT-guided percutaneous coaxial cutting needle biopsy of lung lesions

PURPOSE: To evaluate risk factors for pneumothorax and bleeding,after compu ted tomography (CT)-guided percutaneous coaxial cutting needle biopsy of lu ng lesions. MATERIALS AND METHODS: This study involved 117 consecutive, patients with 1 17 intrapulmonary lesions. Statistical analysis of factors related to patie nt characteristics, lung lesions, and biopsy technique was performed to det ermine possible contribution to the occurrence of pneumothorax and bleeding . Interactions between related factors were considered to prevent colineari ty. RESULTS: Pneumothorax occurred in 12% (14 of 117) of patients. Needle aspir ation of two moderate asymptomatic pneumothoraces were performed; there was no chest tube insertion. Lesion depth (P = .0097), measured from the pleur al puncture site to the edge of the intrapulmonary lesion along the needle path, was the single significant predictor of pneumothorax. The highest ris k of pneumothorax occurred in subpleural lesions 2 cm or shorter in depth ( this represented 33% of lung lesions but caused 71% of all pneumothoraces; OR = 7.1; 95% Cl, 1.3-50.8). Bleeding presented as lung parenchyma hemorrha ge and hemoptysis in 30 patients (26%). Hemoptysis occurred in four patient s (3%). Univariate analysis identified lesion depth (P < .0001), lesion siz e (P < .015), and pathology type (P = .007) as risk factors for bleeding. M ultivariate logistic regression analysis identified lesion depth as the mos t important risk factor, with the highest bleeding risk for lesions more th an 2 cm deep (14% of lesions caused 46% of all bleeding; OR = 17.3; 95% CI, 3.3-121.4). CONCLUSIONS: In CT-guided coaxial cutting needle biopsy, lesion depth is th e single predictor for risk of pneumothorax, which occurs at the highest ra te in subpleural lesions. Increased risk of bleeding occurs in lesions deep er than 2 cm.