Title : The risk of immediate pneumothorax after ultrasound guided percutaneous transthoracic needle biopsy: Wedge shaped lesion as a novel factor
Abstract:
Background: Pneumothorax is a common complication of ultrasound-guided percutaneous transthoracic needle biopsy (US-PTNB), usually occurring immediately after US-PTNB. Once it occurs, it affects the adequacy of sample acquisition. Preventing pneumothorax after US-PTNB requires preoperative assessment of relevant risk factors. This study investigated the risk factors for immediate pneumothorax after US-PTNB.
Methods: Data from consecutive patients who underwent US-PTNB at Shanghai Pulmonary Hospital from January 2024 to December 2024 were retrospectively analyzed to evaluate the incidence of immediate pneumothorax after surgery. 28 parameters, including demographic characteristics, ultrasound imaging features, and procedural factors, that might lead to immediate pneumothorax were analyzed. Univariate and multivariate logistic regression analyses were used to explore independent risk factors for immediate pneumothorax after US-PTNB.
Results: Technical success was not achieved in 4 US-PTNB procedures (0.29%), all of which were stopped due to pneumothorax. Among 1372 US-PTNB procedures, 34 (2.48%) developed immediate pneumothorax after surgery. 2.94% (1/34) of the pneumothorax cases (1/1372, 0.07% of the total US-PTNB procedures) required chest tube placement. The remaining pneumothoraces were managed conservatively. Independent risk factors for immediate pneumothorax included smaller pleural contact length (OR = 0.589, 95% CI: 0.429-0.809; P=0.001), wedge-shaped lesion (OR = 2.952, 95% CI: 1.152-7.563; P=0.024), and the presence of a diffuse air bronchogram within the lesion (OR = 2.510, 95% CI: 1.080-5.835; P=0.033).
Conclusion: Wedge-shaped lesion is a new risk factor leading to immediate pneumothorax and may increase the probability of immediate pneumothorax after US-PTNB. For wedge-shaped lung lesions, physicians should be alert to the risk of immediate pneumothorax after US-PTNB.
Keywords: Ultrasound-guided percutaneous transthoracic needle biopsy (US-PTNB), Pneumothorax, Risk factors
