Percutaneous transthoracic core needle biopsy: 3 factors that influence procedural success
A new analysis details various factors associated with post-procedural complications following percutaneous transthoracic core needle biopsy (PCNB) of peripheral lung lesions.
The location of peripheral lesions limits the use of bronchoscopic biopsy, which is typically used for analyzing central lesions. This is why many providers turn to PCNB, though the procedure itself can be difficult to carry out.
Published in the journal Clinical Radiology, the new analysis is intended to help guide interventional radiologists in their decision-making processes regarding PCNB to reduce the likelihood of diagnostic failure.
“Accessing peripheral lung lesions for PCNB is often challenging, and there are concerns about complications,” Suyoung Park, MD, with the Department of Radiology at Gil Medical Center in the Republic of Korea. “Although several studies have addressed PCNB of pulmonary lesions located in supradiaphragmatic and subfissural areas, there is no comprehensive evaluation of diagnostic failure and complications for peripheral lung lesions, including those in supradiaphragmatic and subfissural areas, based on a relatively large cohort.”
For their work, the researchers retrospectively analyzed a single center’s data from nearly 600 PCNB procedures on lesions in contact with or adjacent (within 1 cm) to the visceral pleura. Using details contained in patients’ electronic health records, radiology reports and procedural reports, the group compared outcomes to determine whether certain factors or lesion characteristics had any impact on diagnostic failures and instances of post-procedure pneumothorax.
Technical and diagnostic success rates were 100% and 90.1%, with just under 20% of the procedures resulting in pneumothorax. Severe adverse events that caused patients to have prolonged hospital stays occurred in 3.4% of the cases.
Researchers determined that three factors were most often linked to procedural failure and/or pneumothorax:
A lesion diameter of less than 10 mm (diagnostic failure).
Providers opting for a transfissural route (pneumothorax).
Longer tract lengths (pneumothorax).
“Previous studies have reported an increased risk for pneumothorax with longer tracts. In our study, we obtained similar results despite performing saline sealing along the entire needle tract,” the authors explained. “A longer tract involves a greater number of pulmonary alveoli, thereby increasing the risk for pneumothorax during needle insertion and delta-shaped needle handling.”
The group added that their findings highlight the safety and efficacy of PCNB, and indicated their work could help providers further improve their procedural success rates.
Learn more about the findings here.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.