Our Summary

This research aimed to understand what factors increase the risk of a lung collapsing (pneumothorax) after a certain type of lung biopsy guided by a CT scan. The study looked at data from 36 articles involving over 23,000 patients.

The main findings were that the chance of a lung collapsing after biopsy was about 26%, and that about 7% of patients also needed a chest drain. The position of the patient during the biopsy was a significant factor. If the patient was lying on their side with the lung being biopsied on the bottom (dependent), the risk of pneumothorax was much lower than if they were lying on their back or front. However, if the patient was on their side but the lung being biopsied was on the top (non-dependent), the risk was much higher.

Other factors increasing the risk included: the biopsy being done from the top side rather than the bottom side of the patient, using larger needles, crossing certain structures in the lung (fissure and bulla), taking multiple samples from different sites, performing biopsies on lungs with emphysema, smaller lesions, lesions that were not in contact with the pleural membrane, and deeper lesions.

These findings can help doctors better plan and perform lung biopsies to minimize the risk of pneumothorax. For instance, they suggest that it might be safer to position patients on their side with the lung being biopsied on the bottom, to use smaller needles, and to use a special technique (coaxial) if multiple samples are needed.

FAQs

  1. What are the risk factors for pneumothorax following a CT-guided percutaneous transthoracic lung biopsy?
  2. How does patient positioning during a lung biopsy affect the risk of pneumothorax?
  3. What strategies can be used to reduce the incidence of pneumothorax during a CT-guided lung biopsy?

Doctor’s Tip

A helpful tip a doctor might tell a patient about lung biopsy is to ensure proper positioning during the procedure, such as being in a lateral decubitus position with the biopsied lung dependent. This can help reduce the risk of developing a pneumothorax. Additionally, using smaller calibre needles and avoiding crossing fissures or bullae during the biopsy can also help lower the risk of complications. It is important to discuss these factors with your healthcare provider before the procedure to ensure the safest possible outcome.

Suitable For

Patients who are typically recommended for a lung biopsy include those with suspicious lung nodules, masses, or other abnormalities seen on imaging studies such as chest x-rays or CT scans. These patients may have symptoms such as coughing up blood, chest pain, shortness of breath, or unexplained weight loss. Additionally, patients with a history of lung cancer or other lung diseases may also be recommended for a lung biopsy to determine the cause of their symptoms or monitor disease progression.

Timeline

Before the lung biopsy:

  1. The patient will undergo a consultation with their healthcare provider to discuss the need for a lung biopsy.
  2. Pre-procedure tests such as blood work, imaging studies, and possibly a lung function test may be conducted.
  3. The patient may be instructed to stop taking certain medications, such as blood thinners, before the procedure.
  4. On the day of the biopsy, the patient will be asked to fast for a certain period of time before the procedure.

After the lung biopsy:

  1. The patient will be monitored in a recovery area for a period of time to ensure there are no immediate complications.
  2. The patient may experience some pain or discomfort at the biopsy site, which can be managed with pain medication.
  3. The patient will be given instructions on how to care for the biopsy site at home, including keeping it clean and dry.
  4. The patient may be advised to avoid strenuous activities for a certain period of time after the biopsy.
  5. The biopsy sample will be sent to a laboratory for analysis, and the patient will follow up with their healthcare provider to discuss the results and any further treatment options.

What to Ask Your Doctor

  1. What is the purpose of the lung biopsy?
  2. What are the potential risks and complications associated with the procedure, specifically pneumothorax?
  3. What are the factors that may increase the risk of developing a pneumothorax during or after the biopsy?
  4. How will the biopsy be performed (e.g. positioning, needle size, technique)?
  5. Will I need a chest drain inserted after the biopsy?
  6. How will the results of the biopsy be communicated to me?
  7. What post-procedure care instructions should I follow?
  8. Are there any alternative diagnostic tests or procedures that could be considered instead of a lung biopsy?
  9. What is the experience of the healthcare team performing the biopsy?
  10. Are there any specific precautions or considerations I should keep in mind before or after the biopsy procedure?

Reference

Authors: Huo YR, Chan MV, Habib AR, Lui I, Ridley L. Journal: Br J Radiol. 2020 Apr 1;93(1108):20190866. doi: 10.1259/bjr.20190866. Epub 2020 Jan 3. PMID: 31860329