Development of a prediction model and risk score for procedure-related complications in patients undergoing percutaneous computed tomography-guided lung biopsy

Michele Anzidei; Beatrice Sacconi; Francesco Fraioli; Luca Saba; Pierleone Lucatelli; Alessandro Napoli; Flavia Longo; Domenico Vitolo; Federico Venuta; Marco Anile; Daniele Diso; Mario Bezzi; Carlo Catalano

doi:10.1093/ejcts/ezv172

Development of a prediction model and risk score for procedure-related complications in patients undergoing percutaneous computed tomography-guided lung biopsy

Eur J Cardiothorac Surg. 2015 Jul;48(1):e1-6. doi: 10.1093/ejcts/ezv172. Epub 2015 May 16.

Authors

Affiliations

¹ Department of Radiological, Oncological and Anatomopathological Sciences - Radiology, 'Sapienza' University of Rome, Rome, Italy.
² Department of Radiological, Oncological and Anatomopathological Sciences - Radiology, 'Sapienza' University of Rome, Rome, Italy [email protected].
³ Institute of Nuclear Medicine, University College London Hospital, London, UK.
⁴ Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari - Polo di Monserrato, Monserrato, Italy.
⁵ Department of Radiological, Oncological and Anatomopathological Sciences - Oncology, 'Sapienza' University of Rome, Rome, Italy.
⁶ Department of Radiological, Oncological and Anatomopathological Sciences- Pathology, 'Sapienza' University of Rome, Rome, Italy.
⁷ Department of Thoracic Surgery, 'Sapienza' University of Rome, Rome, Italy.

PMID: 25983080
DOI: 10.1093/ejcts/ezv172

Abstract

Objectives: To propose a risk score predicting the potential occurrence of procedure-related complications in patients undergoing computed tomography (CT)-guided lung biopsy.

Methods: Institution review board approval was obtained. A total of 342 CT-guided lung biopsies were retrospectively evaluated taking into account procedure-related complications and associated risk factors, including patient gender and age, previous radiation therapy (RT) and/or chemotherapy (CHT), lesion size, depth and location, incomplete pulmonary fissures, associated diffuse lung diseases, previous pneumothorax (PNX), lung volumes, punctured fissures, thoracic access, needle size and operator experience. Complications were assessed on chest X-ray and/or CT scans. Stepwise logistic regression was used to identify risk factors, to evaluate their correlation with procedure-related complications and to calculate models of risk (MoRs).

Results: PNX requiring chest tube placement occurred in 39 patients (11.4%), high-grade pulmonary parenchymal haemorrhage occurred in 62 patients (18.1%) and haemothorax occurred in 12 patients (3.5%). Risk factors increasing the incidence of complications were lesion size (P = 0.01), lesion depth (P = 0.01) and incomplete pulmonary fissures (P = 0.01); previous chemo-radiation therapy was correlated to a lower incidence of complications (P = 0.01). MoR for PNX was as follows: risk base line = 60%; age = +0.15%/year; punctured fissures = +20%; incomplete fissures = +9%; previous CHT/RT = -10%. MoR for parenchymal haemorrhage was as follows: risk base line = 20%, lesion depth = +0.8%/mm; age = +0.25%/year; incomplete fissures = +15%. MoR for haemothorax was as follows: risk base line = 1%; previous PNX = +20%; incomplete fissures = 7%; both previous PNX and incomplete fissures = +67%.

Conclusion: This study provides MoRs to predict the risk of complications in patients undergoing CT-guided percutaneous lung biopsies.

Keywords: CT-guided lung biopsy; Complications; Lung tumour; Pneumothorax; Risk score.

MeSH terms

Adult
Age Factors
Aged
Aged, 80 and over
Female
Humans
Image-Guided Biopsy / adverse effects*
Image-Guided Biopsy / methods
Lung / pathology*
Lung Diseases / pathology
Male
Middle Aged
Models, Statistical
Radiography, Interventional / adverse effects
Radiography, Interventional / methods
Retrospective Studies
Risk Assessment / methods*
Risk Factors
Sex Factors
Tomography, X-Ray Computed / adverse effects
Tomography, X-Ray Computed / methods
Young Adult