CT guided biopsies as a part of the investigations in findings in the lung and thorax wall. A retrospective study of the findings and complications

Introduction: The widespread use of CT have resulted in an increased detection of pulmonary lesions, and not only detected at an increased rate but also at a smaller size. CT guided lung biopsies are now more frequently being used compared to fluoroscopy guidance. The main aim of this paper is to investigate the facts connected to the biopsies concerning complications. More specific comparing the complication rate to patient and procedure parameters such as age, lung function, smoking habits, comorbidity, patient position during the biopsy, lesion size and biopsy route.
Methods: We retrospectively collected the results and information from 520 CT guided thorax biopsies. All biopsies were performed with CT guided “beam-through” technic, using a 64 slice CT scanner. Core needle biopsies were performed with an 18 Gauge core needle in most patients, only in 10 patients a fine needle aspiration was performed.
Results: In 86 % of the biopsies, the tissue material was found sufficient. In 32 % of the biopsies there was a complication, mostly pneumothorax (30%), but in only 15 % of the 520 cases chest drainage was needed. There was one death in a known cancer patient with severe reduced lung and cardiac function. Patients with more than 10 cigarette pack years had a complication risk twice as high compared to patients with less pack years.
We found that the risk of pneumothorax rises the further the lesion is from the skin surface, the smaller the lesions are and when the patient is biopsied in a lateral position. We found a higher risk of complications in females.

Conclusion: CT guided biopsy is an excellent tool in the analysis of lesions in the lungs. This study clearly shows that the risk of developing a pneumothorax is significantly higher among smokers and former smokers with more than 10 pack years.