CT Guided Biopsy – a Review of a Interventional Service with Regards to Pneumothorax Rates

Introduction: The number of computed tomography guided biopsies (CTGB) performed to investigate lung cancer is increasing but the main risk of CTGB is pneumothorax (up to 26%). Northumbria Healthcare National Health Service Foundation Trust runs a large cancer and pleural service, with radiologists and physicians working in close collaboration. Local data regarding performance and complications are important to inform patient care. Methods A service review was performed using locally available data from radiology with local information governance approval. Simple demographics and outcomes were collected regarding CTBG patients over April 2011 to July 2023. The data was analysed and presented descriptively. Where possible, continuous variables are presented as median with interquartile range (IQR) and categorical variables were expressed as frequencies (n) and percentages (%). Results 1492 CTGB were performed. Median age was 72 years (IQR 10.5), with 760 (50.9%) males undergoing CTGB. There were 355 pneumothoraces (23.8%) overall. 159 (44.8%) of those were visible on the post biopsy check CT. The mean number of pleural passes was 1.8 (range 1-4). Of those who had pneumothoraces, 53.6% had radiological emphysema, median forced expiratory volume in 1 second (FEV1) was 1.97 litres (IQR 1.04), 67% had no pleural contact, median size of lesion was 26 millimetres (mm) (IQR 24), 72% lesions were less than 3 centimetres (cm) deep, and majority of biopsies (44%) were with 18 French gauge (F)r tru-cut needles, as depicted in Figure 2. Of the 355 pneumothoraces, 315 (89%) pneumothoraces were managed conservatively (88.7%), 42 had a pleural intervention (41 small bore, 12Fr intercostal chest drains and 1 one pleural vent). - 40 had symptoms at outset and 2 up to 7 days later. Conclusion The rate of pneumothorax is within expected limits, and more likely when biopsying smaller lesions with no pleural contact and surrounding radiological emphysema and with more than 1 pleural pass. Fev1 does not seem to have a bearing on the risk of pneumothorax for CTGB. Conservative management is commonplace.