Use of trans-pleural hydrogel foam plugs for reducing pneumothorax complicating CT-guided lung biopsy.

Transcription

1 Use of trans-pleural hydrogel foam plugs for reducing pneumothorax complicating CT-guided lung biopsy. Poster No.: C-2483 Congress: ECR 2013 Type: Authors: Keywords: DOI: Scientific Exhibit Z. Sheikh, M. Charig; Slough/UK Cancer, Biopsy, CT, Respiratory system, Interventional nonvascular /ecr2013/C-2483 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 7

2 Purpose CT guided lung biopsy is a proven diagnostic method for lung lesions, and is frequently used for the diagnosis of suspected lung malignancy However, post-biopsy pneumothorax from this procedure is a common complication, reported to occur in upto 12-36% of cases. 1 This can cause significant morbidity, resulting in repeated hospital attendence with possible chest drain insertion and hospitalisation. The use of trans-pleural hydrogel plugs to reduce post-biopsy pneumothorax has been previously described in two studies. 2,3 We saught to evaluate the effectiveness of this intervention at our centre. The risk of pneumothorax is significantly higher for core biopsies than for fine needle aspiration (FNA), with the former being increasingly preferred for accurate histological diagnosis. Other risk factors which predispose to post-biopsy pneumothorax include lesion distance from pleura (> 2cm at point of biopsy), smoking status, and the presence of emphysema or a known diagnosis of COPD. 4 Many interventions have been evaluated to help reduce this complication, including the infiltration of autologous blood clots and normal saline into the biopsy tract. 5,6 However, there is no consensus in the reported literature to suggest the effectiveness of either of these interventions in routine clinical practice. Images for this section: Page 2 of 7

3 Fig. 3: CT guided lung lesion biopsy. Page 3 of 7

4 Methods and Materials A retrospective cohort of CT guided lung biopsy procedures done between August 2006 and March 2012 by a single consultant radiologist were analysed. The operator used clinical judgment to discern whether or not there was a high procedural risk of pneumothorax. High risk patients had transpleural hydrogel foam injected via a coaxial needle as it was withdrawn to plug the biopsy tract. Electronic radiology records (Centricity PACS) were reviewed and complications of pneumothorax and the need for subsequent intervention was noted. Cases of ultrasound guided biopsy and pleural biopsy were excluded from analysis. Patients were divided into a control (no hydrogel plug) and experimental (hydrogel plug) groups. History of smoking and a known diagnosis of COPD was recorded from electronic patient records. A trained doctor measured the distance of each biopsied lung lesion from the pleura on available CT images taken during biopsy. A univariate analysis was performed for determining the risk of post-biopsy pneumothorax in the experimental and control groups. Regression analysis was performed on the most significantly correlated risk factors for pneumothorax from the univariate analysis, to adjust for any confounding between the two groups. Histology reports from biopsy procedures were reviewed to see if adequate tissue was obtained for diagnosis. The need for repeat biopsy or futher investigation was noted from electronic patient records. Results A total of 221 core biopsy procedures in 217 patients were included for analysis. The mean age was 65.5 years (median 70) and 54.8% of patients male (n = 121). There were 118 cases in the control group and 103 cases in the experimental group. In the experimental group 34% (n=35) of cases had a pneumothorax and 4.9% (n=5) of the group required chest drain or throacid vent insertion. In the control group 28% (n=33) of cases were complicated by pneumothorax and 5.9% (n = 7) required chest drain insertion. Further analysis revealed that the increased pneumothorax rate in the experimental group was not statistically significant (OR 1.12, p = 0.73). However, there was a significantly higher risk of COPD (OR 2.46, p = 0.01, 95% CI ) and lesion depth > 2cm (OR 3.28, p < 0.001, 95% CI ) in experimental group. Page 4 of 7

5 In the experimental group sampling adequacy for CT guided biopsies was 85.4% (n = 88) with the remainder of patient being referred to further imaging (eg. PET) or undergoing further biopsy (bronchoscopy, mediastinoscopy). The cases where inadequate histological samples were obtained for diagnosis (n = 15) included 3 cases for which no histology report was available. In the control group the sampling adequacy was 83.9% (n = 99) including 4 cases for which the histology report was not available and 1 case in which no biopsy was obtained due to immediate pneumothorax. Images for this section: Fig. 1: A comparison of the experimental and control group. Fig. 2: Odds ratios for pneumothorax and confounders for patients in the experimental group versus the control group. Page 5 of 7

6 Conclusion Previous authors have reported a significantly greater benefit in patients undergoing CT guided lung biopsy treated with hydrogel foam plugs than observed in the current series. Several methodological differences could account for some of this discrepency, including the retrospective nature of our study and the lack of any randomisation or bliding. However, previous studies have not adjusted for the presence COPD or lesion depth, and these are known confounders for the development of pneumothorax. Hence, this makes a direct comparison difficult. In our study the use of trans-pleural hydrogel plugs achieved a comparable pneumothorax rate in patients that were at a higher risk for post-biopsy pneumothorax. This allowed for safe biopsy without compromise in sampling adequacy or a significantly higher rate of pneumothorax. As hydrogel foam injections are a significant cost (~Euro 100), more research is required to justify its routine use in clinical practice. Our results suggest that this treatment may have a role in patients at high risk of pneumothorax. References 1. #Tomiyama N et al. CT-guided needle biopsy of lung lesions; A survey of severe complication based on 9783 biopsies in Japan. Eur J Radiol 2006; 59(1): Engeler CE et al. Pneumothorax after lung biopsy: prevention with transpleural placement of compressed collagen foam plugs. Radiology 1992; 184(3): Zaetta JM, Licht MO, Fisher JS, Avelar RL. A lung biopsy tract plug for reduction of postbiopsy pneumothorax and other complications: results of a prospective, multicenter, randomized, controlled clinical study. J Vasc Interv Radiol 2010; 21(8): #Yeow KM et al. Risk factors of pneumothorax and bleeding: multivariate analysis of 660 CT-guided coaxial cutting needle lung biopsies. Chest 2004;126: Billich C et al. CT-guided lung biopsy: incidence pf pneumothorax after instillation of NaCl into the biopsy track. Eur Radiol 2008; 18: Anderson CL, Pointon KS, Manhire AR, Macfarlane JT. Percutaneous lung biopsies: a survey of UK practice based on 5444 biopsies. Br J Radiol 2002;75:731-5 Page 6 of 7

7 Personal Information Page 7 of 7