Title : Ultrasound guided percutaneous transthoracic lung biopsy: Evaluating the risk factors of fost-procedure hemoptysis
Abstract:
Background: Ultrasound-guided transthoracic percutaneous lung biopsy (US-PTLB) is a widely used method for diagnosing pulmonary diseases. However, hemoptysis caused by US-PTLB is often unexpected, and this complication can be life-threatening.
Objective: The purpose of this study is to evaluate the incidence of hemoptysis as a complication of US-PTLB and explore its associated risk factors.
Methods: We retrospectively analyzed data from consecutive patients who underwent US-PTLB at Shanghai Pulmonary Hospital between January 2024 and June 2024 to evaluate the incidence of postoperative hemoptysis. The study variables were divided into three categories: patient clinical characteristics (age, gender, preoperative prophylactic use of hemostatic drugs), lesion parameters (pathology, size, pleural contact length, shape, location, proximity to heart or major vessels, complete pleural attachment, respiratory sliding, angle with pleura, boundary, echogenicity, echotexture homogeneity, pleural invasion, air bronchogram grading, blood flow richness, strain elastography score, contrast-enhanced ultrasound perfusion pattern, start enhancing time, peak intensity, non-perfused area size), and procedural parameters (technique, number of needle passes, puncture path length, operator experience, procedure duration). Univariate analysis was performed to evaluate risk factors for hemoptysis, followed by multivariate logistic regression analysis to identify independent risk factors.
Results: A total of 564 patients were included, with 20 cases (3.55%) developing hemoptysis. Univariate analysis revealed that age (P < 0.001), preoperative use of hemostatic drugs (P = 0.021), lesion location (upper lobe or middle/lower lobe, back or other) (P = 0.035 and P = 0.008, respectively), lesion shape (P = 0.002), and operator experience (P = 0.029) were statistically significant factors between the hemoptysis and non-hemoptysis groups. Multivariate analysis identified age (≤56 years) (OR = 5.766; 95% CI: 2.190–15.186; P < 0.001) and lesion shape (non-circular) (OR = 4.471; 95% CI: 1.241–16.103; P = 0.022) as independent risk factors for hemoptysis after US-PTLB.
Conclusion: Our study found that the incidence of hemoptysis as a complication of US-PTLB was 3.55%, with most cases being non-severe. Patient age (≤56 years) and lesion shape (non-circular) were identified as independent risk factors for postoperative hemoptysis. Therefore, for cases with these risk factors, sonographers should be prepared to manage potential hemoptysis.
Keywords?Ultrasound-guided percutaneous transthoracic lung biopsy(US-PTLB), Hemoptysis, Risk factors
