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Considerable risk of pneumothorax seen with transthoracic needle lung biopsy

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Pneumothorax occurs in 15% of patients having a transthoracic needle biopsy of a pulmonary nodule, according to the findings of a population-based cross-sectional study reported in the Annals of Internal Medicine for August 2.

“Although our study does not address the long-term risk-benefit trade-off of whether to pursue biopsy, our population-based data on short-term risk for complications of CT-guided biopsy may help both patients with pulmonary nodules and their physicians make more informed decisions,” the authors state.

Whether to perform a biopsy is an increasingly common issue, given that pulmonary nodules are seen in up to 25% chest CT scans, note Dr. Renda Soylemez Wiener, at Boston University School of Medicine in Massachusetts, and colleagues

To determine the risk of complications from transthoracic needle lung biopsy, the team analyzed data from the 2006 state databases of California, Florida, Michigan, and New York from the Healthcare Cost and Utilization Project. The data included 15,865 CT-guided single biopsies of a pulmonary nodule.

Hemorrhage occurred in just 1% of cases, but 17.8% of these patients required a blood transfusion, the investigators found. Pneumothorax of any severity, as mentioned, occurred in 15% of biopsies, and in 6.6% of cases it required a chest tube.

Respiratory failure occurred more often in patients with hemorrhage (4.3%) or pneumothorax requiring a chest tube (1.4%) than in patients without complications (0.6%), according to the report. The risk of complications was highest in patients between the ages of 60 and 69, in smokers, and in patients with COPD.

“Our data suggest that several thousand persons in the United States experience complications of CT-guided biopsy each year,” Dr. Wiener and colleagues comment.

“For many patients, including those with a low risk for cancer, those who are too frail to undergo cancer treatment, or those with a high risk for cancer who should proceed directly to surgery, this procedure may be unnecessary” they continue. “Before exposing patients to potential harm from CT-guided biopsy, physicians must ensure that patients understand the risks.”

Ann Intern Med. 2011;155:137-144.