Institutional Review of Incidence of Pneumothorax in Transthoracic Lung Biopsies and Efficacy of Autologous Blood Clot Seal

Background: Image-guided transthoracic lung biopsy is a widely accepted technique for the workup of lung lesions. Screening for lung cancer and the growing need for research biopsy samples will continue to increase the demand for image-guided lung biopsy. With the widespread use of cross sectional imaging and multidetector CTs, most centers have shifted their practice to performing lung biopsies under CT guidance. Pneumothorax is the most common complication of transthoracic lung biopsy. A patient with stable pneumothorax may be treated conservatively without chest tube insertion. If pneumothorax is large (greater than 30% of hemithorax), it is rapidly expanding or is causing symptoms, chest tube insertion is warranted. The reported rates of pneumothorax and chest tube placement vary greatly in the published literature. In some of the larger series, pneumothorax was encountered in 20 to 25% of patients, and chest tube was inserted in 0 to 17% of patients. This leads to increased patient discomfort and increased cost of the investigation. This was single-center institutional review to evaluate the incidence of pneumothorax post–lung lesion biopsy and assessment of efficacy of the autologous blood clot seal.

Materials and Methods: A total of 54 patient who underwent CT-guided lung biopsy from July 2018 to April 2019 were included in this clinical audit. Preprocedural workup was performed in all patients. Each patient underwent a percutaneous lung biopsy using conventional CT scan guidance with a coaxial image. Each patient was placed in the prone or supine position during the procedure. After obtaining the core biopsy samples, autologous blood clot seal was used to plug the biopsy tract. Postprocedure check, CT was performed to detect pneumothorax.

Results: The incidence of pneumothorax was less than 2% in our study population which is much less found in literature. This is attributed to the stringent safety protocol followed, viz., patient selection and preparation, single-puncture technique, short distance to the lesion, and use of autologous blood patch.

Conclusion: Lung biopsy should be planned carefully to select the shortest path to the lesion while avoiding multiple punctures of the pleural linings or traversing emphysematous lung parenchyma. Use of autologous blood clot to seal the biopsy tract significantly reduces the incidence of pneumothorax.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
14 December 2021