1. 2nd Eurasian Respiratory and Allergy Summit
Eyüp Şenol, MD Atatürk Chest Disease and Thoracic Surgery Training and Research Hospital, Department of Radiology, Ankara, TURKEY
2nd Eurasian Respiratory and Allergy Summit
Budva, MONTENEGRO
21-24 September 2017

2. 2nd Eurasian Respiratory and Allergy Summit
Factors Affecting the Accuracy of Diagnosis and Complications in Computed Tomography Guided Transthoracic Percutaneous Lung Biopsy
2nd Eurasian Respiratory and Allergy Summit
Budva, MONTENEGRO
21-24 September 2017

3. Introduction
Computed Tomography (CT) guided transthoracic lung biopsy (NLB) has been known as a gold standard for diagnosis of lung lesions.
Being less invasive, safer, more affordable and quicker than thoracotomy and having accurate diagnosis for the most lesions are the main advantages of this procedure.
Besides its advantages NLB has some life-threating complications like pneumothorax and hemothorax.

4. Introduction
Efforts are introduced to increase the patient compliance, comfort and performance of biopsy in order to reduce the complications of NLB and increase the accuracy of diagnosis.
We aimed to examine the factors affecting the complications and the accuracy of diagnosis by the CT-guided lung biopsy.

5. Materials and Methods
Within one year period 200 transthoracic co-axial needle biopsy were analyzed retrospectively.
Patients who were over 18 years old and eligible with respect to lung capacity, coagulation parameters and vital signs and who had parenhcymal lung lesions were included in this study.
17/18 Gauge co-axial needles were used for one hundred patients and 19/20 Gauge were used for the rest of the other one hundred patients.

6. Measures Age Gender Co-morbidities Medications Coagulation parameters
FEV1/FVC rate
Cigarette pack year
Used needle type
Patient position
Chest wall thickness
Presence of pleural effusion
Lesion size
Lesion location
Lesion distance from pleura
FDG uptake of lesion in PET-CT
Entrance angle of needle to pleura
Length of intrapulmonal biopsy path
Number of pleural needle passes
Number of manipulations in needle passages
Complications seen due to procedure
Length of procedure
Histopathologic diagnosis

7. Results Mean age of the patients was 61,9±10,95 (25-86)
164 (82%) of patients were male, 36 (18%) of patients were female
Mean cigarette package year was 42,3 ± 32,4 (0-150)
Frequency of co-morbidities;
DM n=42 (21%)
HT n=65 (33%)
CAD n=26 (13%)
COLD n=32 (16%)
Hypothyroidism n=7 (4%)
Psychiatric disease n=6 (3%)
BPH n=3 (1,5%)
Tuberculosis n=2 (1%)
Buerger disease n=3 (1,5%)
Non-lung malignancy n=4 (2%)

8. Results Variables Mean Standard Deviation FEV1/FVC rate 77,7 8,1
Lesion size (mm)
4,8
4,2
Lesion distance from pleura (cm)
1,5
1,8
FDG uptake of lesion in PET-CT
9,5
5,8
Number of pleural needle passes
1,1
0,4
Number of manipluations in needle passages
0,8
Length of procedure (min)
6,7
2,8

9. Results

10. Results

11. Results Factors effecting accuracy of diagnosis
U-FDG
Mean
Standard Deviation
Median
Min
Max
p value
Malignant*
11.8
5.07 11 3 26
Non-diagnostic
7.5
6.3 6 33
p<0.001
Inflammation
4.2 5 2 17
According to Kruskal-Wallis test; as shown the details in table, FDG uptake of lesion in PET-CT could able to differantiate the diagnosis of malignancy group from inflammation and undiagnosed groups significantly.
There was no significant relationship between accuracy of diagnosis and other variables except U-FDG.

12. Results Complications
Pneumothorax occured in 31 of 200 patients (15,5%).
Perilesional hemorrhage occured in 83 of 200 patients (41,5%).
Hemoptysis occured in 8 of 200 patients (4%).
Hypotension occured in 5 of 200 patients (2.5%) and hypertension occured in 1 of 200 patients (0.5%).

13. Results Pneumothorax Hemorrhage Age p=0.008 p=0,809 Gender p=0,470
Co-morbidities
p>0,05
Coagulation parameters
FEV1/FVC rate
p=0,817
p=0,156
Cigarette pack year
p=0,874
p=0,119
Used needle type
p=0,171
p=0,952
Patient position
p=0,825
p=0,185
Chest Wall thickness
p=0,844
p=0,552
Pleural effusion
p=0,896
p=0,225

14. Results Pneumothorax Hemorrhage Lesion size p=0.032 p<0,001
Lesion location
p=0,977
p=0,840
Lesion distance from pleura
p=0,05
FDG uptake of lesion in PET-CT
p=0,404
p=0,011
Entrance angle of needdle to pleura
p=0,444
p=0,680
Length of intrapulmonal biopy path
p=0,543
p=0,012
Number of pleural needle passes
p<0.001
p=0,132
Number of manipulations in needle passages
p=0.008
Length of procedure
p=0.002
Histopathologic diagnosis
p>0.05
p>0,05

15. Results
There were positive correlations between age, lesion distance from pleura, number of pleural needle passes, length of procedure and risk of penumothorax.
There was negative correlation between lesion size and risk of pneumothorax.
There were positive correlations between lesion distance from pleura, length of intrapulmonal biopsy path, length of procedure, number of manipulations in needle passages and risk of perilesional hemorrhage.
There were negative correlations between lesion size, FDG uptake of lesion in PET-CT and risk of hemorrhage.

16. Results Logistic regression analysis for pneumothorax
One Variable
Multiple variables
Variables p
Exp(B)
%95 CI
Age
0,016
0,029
1.049
1.005
1.094
Number of pleural needle passes
0,002
0,051
2.893
0.996
8.402
Length of procedure
<0.001
0,05
1.142 1
1.305
Our logistic regression model as shown in table found that the age, confers a 1 fold increase risk for the development of pneumothorax complication.
Number of pleural needle passes, confers a 2,9 fold increase risk for the development of pneumothorax complication.
Length of procedure, confers a 1,1 fold increase risk for the development of pneumothorax complication.

17. Results Logistic regression analysis for hemorrhage
One Variable
Multiple variables
Variables p
Exp(B)
%95 CI
Lesion distance from pleura
p<0,001
0,009
1.295
1.067
1.570
Lesion size
0,625
0,507
0,772
Length of procedure
Number of manipulations in needle passages
0,029
2,484
1,098
5,619
Our logistic regression model as shown in table found that the lesion distance from pleura, confers a 1,3 fold increase risk for the development of hemorrhage complication.
Lesion size confers a 1,6 fold decrease risk for the development of hemorrhage complication.
Number of manipulations in needle passages, confers a 2,5 fold increase risk for the development of hemorrhage complication.

18. Conclusion
Patient’s age, number of pleural needle passes and length of procedure were posing greatest risks for pneumothorax complication during transthoracic lung biopsy.
Lesion distance from pleura, lesion size, number of manipulations in the needle passages were posing greatest risks for hemorrhage.
FDG uptake of lesion in PET-CT was the most important factor for accuracy of diagnosis.

19. Conclusion
According to our study results, in order to reduce complications due to transthoracic lung biopsy procedure, we should minimalise the number of pleural needle passes, manipulations in the needle trace and the length of procedure especially for older patients with small lesions which are far from pleura.
For detecting the accuracy of the histopathological tissue diagnosis, our study results showed that the malignant lesions can be differantiated from undiagnosed and the inflamation groups by the FDG uptake of lesion in PET-CT.

20. THANK YOU…