Combined autologous blood patch-immediate patient rollover does not reduce the pneumothorax or chest drain rate following CT-guided lung biopsy compared to immediate patient rollover alone

• Published in: European journal of radiology Vol. 160; p. 110691
• Main Authors: Duignan, John A., Ryan, David T., O'Riordan, Brian, O'Brien, Amy, Healy, Gerard M., O'Brien, Cormac, Butler, Marcus, Keane, Michael P., McCarthy, Cormac, Murphy, David J., Dodd, Jonathan D.
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.03.2023
• Subjects: Blood patch; Cohort Studies; CT fluoroscopy-guided lung biopsy; Humans; Image-Guided Biopsy - adverse effects; Image-guided Biopsy/methods; Lung - diagnostic imaging; Lung - pathology; Pneumothorax; Pneumothorax - epidemiology; Pneumothorax - etiology; Pneumothorax - prevention & control; Radiography, Interventional - methods; Retrospective Studies; Risk Factors; Tomography, X-Ray Computed - methods; Blood patch; Image-guided Biopsy/methods; Pneumothorax; CT fluoroscopy-guided lung biopsy; Pneumothorax/prevention & control; IPR; ABP
• ISSN: 0720-048X; 1872-7727
• DOI: 10.1016/j.ejrad.2023.110691

•Combined ABP-IPR did not reduce pneumothorax or chest drainage compared to IPR alone and may be a safer approach following CT-guided lung biopsy.•Pneumothorax predictors adjusted for ABP-IPR and IPR alone included age, lesion size, location, patient position, emphysema, and lesion-pleura distance,•Chest drainage predictors adjusted for ABP-IPR and IPR alone included lesion location, patient position, bullae crossed and lesion-pleura distance. The purpose of this study was to evaluate a combined autologous blood-patch (ABP)-immediate patient rollover (IPR) technique compared with the IPR technique alone on the incidence of pneumothorax and chest drainage following CT-guided lung biopsy. In this interventional cohort study of both prospectively and retrospectively acquired data, 652 patients underwent CT-guided lung biopsy. Patient demographics, lesion characteristics and technical biopsy variables including the combined ABP-IPR versus IPR alone were evaluated as predictors of pneumothorax and chest drain rates using regression analysis. The combined ABP-IPR technique was performed in 259 (39.7 %) patients whilst 393 (60.3 %) underwent IPR alone. There was no significant difference in pneumothorax rate or chest drains required between the combined ABP-IPR vs IPR groups (p =.08, p =.60 respectively). Predictors of pneumothorax adjusted for the combined ABP-IPR and IPR alone groups included age (p =.02), lesion size (p =.01), location (p =.005), patient position (p =.008), emphysema along the needle track (p =.005) and lesion distance from the pleura (p =.02). Adjusted predictors of chest drain insertion included lesion location (p =.09), patient position (p =.002), bullae crossed (p =.02) and lesion distance from the pleura (p =.02). The combined ABP-IPR technique does not reduce the pneumothorax or chest drain rate compared to the IPR technique alone. Utilising IPR without an ABP following CT-guided lung biopsy results in similar pneumothorax and chest drain rates while minimising the potential risk of systemic air embolism.