Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
권호 표지

Incidence and Risk Factor of Pneumothorax After Percutaneous Fine Needle Aspiration Biopsy of the Lung

경피폐세침흡인생검시 기흉의 발생빈도와 위험인자

  • Choi, Cheon Woong (Department of Internal Medicine, School of Medicine, Kyung Hee University) ;
  • Yoo, Jee Hong (Department of Internal Medicine, School of Medicine, Kyung Hee University) ;
  • Chin, Hyoun Jung (Department of Internal Medicine, School of Medicine, Kyung Hee University) ;
  • Park, Myoung Jae (Department of Internal Medicine, School of Medicine, Kyung Hee University) ;
  • Kang, Hong Mo (Department of Internal Medicine, School of Medicine, Kyung Hee University)
  • 최천웅 (경희대학교 의과대학 내과학교실) ;
  • 유지홍 (경희대학교 의과대학 내과학교실) ;
  • 진현정 (경희대학교 의과대학 내과학교실) ;
  • 박명재 (경희대학교 의과대학 내과학교실) ;
  • 강홍모 (경희대학교 의과대학 내과학교실)
  • Published : 20040000
Download PDF
⟨ Previous Next ⟩

Abstract

Background : Percutaneous needle aspiration biopsy(PNAB) of the lung is a safe procedure for diagnosis of various pulmonary diseases but complications such as pneumothorax can occasionally develop. We reviewed the complications arising after PNAB and analysed the risk factors of pneumothorax. Method : We collected data by reviewing medical records and radiographic studies of 403 patients who underwent PNAB of the lung between 1988 and 2002 and analyzed the risk factors of pneumothorax. Result : The incidence of complication was 12.9%, 48 patients with pneumothorax and 4 patients with mild hemoptysis. Among the 48 pneumothorax patients, 35 patients showed mild(<20%) and was treated by only oxygen supply, 11 patients had severe pneumothorax(>50%) and chest tube insertion was done and 2 patients were treated by needle aspiration. As the results of multivariate analysis, size and location of lesion, location of approach, diagnosis of lesion showed no significant relationship, while age and gender of patients(p<0.05) and the depth of approach(p<0.001) were significantly related to pneumothorax. Smoking amount(p<0.001) as well as the smoking history(p<0.005) were also significantly related and the examiner displaying various incidence of pneumothorax from 4.0% to 23.1% among individuals also was a significant independent risk factor(p<0.05). While the average depth of approach for 13 patients treated by chest tube insertion or needle aspiration was $8.2{\pm}1.2cm$, 35 patiens treated only by oxygen supply was $6.7{\pm}1.6cm$ suggesting that the depth of approach was lead to a severe pneumothorax. Conclusion : The independent risk factors of pneumothorax, the most common complication after PNAB, are age and gender of patients, depth of approach, examiner of procedure, smoking history and smoking amount.

연구배경 : 경피폐세침흡인생검술은 비교적 간편하고 안전한 검사이기 때문에 여러 가지 폐병변의 진단에 유용한 검사로 알려져 있으나 때때로 기흉 등의 합병증이 발생할 수 있다. 저자들은 경피폐세침흡인생 검술 후 발생하는 합병증의 빈도 및 합병증 중 제일 많은 부분을 차지하는 기흉의 위험인자를 알아보고자 하였다. 대상 및 방법 : 1988년에서 2002년 사이에 다양한 폐병변의 진단을 목적으로 경희의대부속병원 호흡기내과에서 경피폐세침흡인생검술을 시행 받은 403명을 대상으로 의무기록과 방사선검사결과를 후향적으로 검토하여 자료를 수집하였다. 결 과 : 총 403명의 환자들 중(남자 245명, 여자 158명) 209명이 악성질환으로, 194명이 양성질환으로 나타났으며, 평균연령은 $58.5{\pm}12.7$세였고, 검침의 평균 깊이는 $6.3{\pm}1.7cm$, 193명이 흡연자였다. 합병증으로는 기흉이 48명, 경미한 객혈이 4명으로 총 발생률은 12.9%였다. 48명의 환자 중 35명이 20% 미만의 기흉으로 산소공급만으로 치료를 받았고, 11명이 50% 이상의 심한 기흉으로 흉관삽입을 시행 받았으며 나머지 2명은 주사기 흡인으로 치료받았다. 기흉발생의 위험요인에 대한 다변량분석을 시행한 결과 병변의 크기와 위치, 검침의 위치, 병변의 진단 등은 관계가 없었으나 환자의 나이와 성별(p<0.05), 검침의 깊이(p<0.001)는 기흉의 발생과 밀접한 관계를 보였다. 흡연유무(p<0.005)뿐만 아니라 흡연량(p<0.001) 또한 기흉발생과 의미 있는 관계를 나타냈으며 각각 4.0%에서 23.1%까지 다양한 발생률을 보인 검사자도 기흉발생의 의미 있는 독립적 위험인자로 나타났다. 한편 산소공급만으로 치료받은 35명의 검침의 평균깊이는 $6.7{\pm}1.6cm$인데 비해 나머지 13명의 심한 기흉환자는 $8.2{\pm}1.2cm$로 검침의 깊이가 깊을수록 심한 기흉이 발생함을 알 수 있었다. 결 론 : 경피폐세침흡인생검은 합병증이 적은 비교적 안전한 검사이며 검사 후 발생하는 가장 흔한 합병증인 기흉의 독립적인 위험인자로는 환자의 나이와 성별, 검침의 깊이, 검사자, 흡연유무 및 흡연량 등이다.

Keywords

References

  1. Stanley JH, Fish GD, Andriole JG. Lung lesions: cytologic diagnosis by fine-needle biopsy. Radiology 1987;162:389-91
  2. 권용화, 김은숙, 주정희, 이상길, 전석철, 함창곡 등. 흉부 병소의 세침흡인 생검. 대한방사선의학회지 1989;25:523-9
  3. Perlmutt LM, Johnston WW, Dunnick NR. Percutaneous transthoracic needle aspiration: A review. AJR 1989;152:451-5
  4. Westcott JL. Direct percutaneous needle aspiration of localized pulmonary lesions: Results in 422 patients. Radiology 1980;137:31-5
  5. Lalli AF, McCormack LJ, Zelch M, Reich NE, Belovich D. Aspiration biopsies of chest lesions. Radiology 1978;127:35-40
  6. 김선미, 전석철, 배오근, 최요원, 함창곡, 김창호 등. 흉부 세침흡인생검: 1000예의 진단성적 및 합병증. 대한방사선의학회지 1994;31:897- 900
  7. Fennessy JJ, Fry WA, Manalo-Estrella P, Hidaegi DV. The bronchial brushing technique for obtaining cytologic specimens from peripheral lung lesions. Acta Cytol 1970;14:25-30
  8. Jereb M. The usefulness of needle biopsy in chest lesions of different sizes and locations. Radiology 1980;134:13-5
  9. Leyden H. On infectious pneumonia. Dtsch Med Wochenschr 1883;9:52-64
  10. Martin HE, Ellis EB. Biopsy by needle puncture and aspiration. Ann Surg 1930;92:169
  11. Khouri NF, Stitik FP, Erozan YS, Gupta PK, Kim WS, Scott WW Jr, et al. Transthoracic needle aspiration biopsy of benign and malignant lung lesions. AJR 1985;144:281-8
  12. Fish GD, Stanley JH, Miller KS, Schabel SI, Sutherland SE. Postbiopsy pneumothorax : estimating the risk by chest radiography and pulmonary function tests. AJR 1988;150:71-4
  13. Welch TJ, Sheedy PF 2nd, Johnson CD, Johnson CM, Stephens DH. CT-guided biopsy: prospective analysis of 1000 procedures. Radiology 1989;171:493-6
  14. Anderson CL, Crespo JC, Lie TH. Risk of pneumothorax not increased by obstructive lung disease in percutaneous needle biopsy. Chest 1994;105:1705-8
  15. Kazerooni EA, Lim FT, Mikhail A, Martinez FJ. Risk of pneumothorax in CT-guided transthoracic needle aspiration biopsy of the lung. Radiology 1996;198:371-5
  16. Yankelevitz DF, Henschke CI, Davis SD, Goldberg S. Pneumothorax during fluorosco pic biopsy:effect on nodule depth. Clin Imaging 1994;18:96-8
  17. Menetrier P. Cancer primitif du poumon. Bull Soc Anat Paris 1886;61:21
  18. Tao LC, Pearson FG, Delarue NC. Percutaneous fine-needle aspiration biopsy: Its value to clinical practice. Cancer 1980;45:1480
  19. Tao LC, Sanders DE, McLoughlin MJ, Weisbrod GL, Hd CS. Current concepts in fine-needle aspiration biopsy cytology. Hum Pathol 1980;11:94-6
  20. Weisbrod GL. Transthoracic percutaneous lung biopsy. Radiol Clin North Am 1990;28(3): 647-55
  21. House AJ, Thomson KR: Evaluation of a new transthoracic needle for biopsy of benign and malignant lung lesions. AJR 1997;129:215-20
  22. Bandt PD, Blank N, Castellino RA. Needle diagnosis of pneumonitis: value in high risk patients. JAMA 1972;220:1578-80
  23. Castellino R, Blank N. Etiologic diagnosis of focal pulmonary infection in immunocom promised patients by fluoroscopically guided percutaneous needle aspiration. Radiology 1979;132:563-7
  24. Adler OB, Rosenberger A, Peleg H. Fine needle aspiration biopsy of mediastinal masses: evaluation of 136 experiences. AJR 1983;140:893-6
  25. Weisbrod GL, Lyons DJ, Tao LC, Chamberlain DW. Percutaneous fine needle aspiration biopsy of mediastinal lesions. AJR 1984;143:525-9
  26. Weisbrod GL. Percutaneous fine-needle aspiration biopsy of the mediastinum. Clin Chest Med 1987;8:27-41
  27. Westcott JL. Percutaneous needle aspiration of hilar and mediastinal masses. Radiology 1981;141:323-9
  28. Haramati LB, Austin JH. Complications after CT-guided needle biopsy through aerated versus nonaerated lung. Radiology 1991;181:778
  29. 양석철, 김연수, 김순길, 김태화, 이경상, 윤호주 등. 국소적 흉부 병변에서 세침흡인생검의 진단성적 및 합병증. 결핵 및 호흡기질환 1995;42(5):685-94
  30. Sagel SS, Ferguson TB, Forrest JV, Ropper CL, Weldon CS, Clark RE. Percutaneous transthoracic aspiration needle biopsy. Ann Thorc Surg 1978;26:399-405
  31. 박재형, 임덕, 임정기, 한용철, 김건열, 함의근. 국소적 폐질환의 경피적 폐 생검. 대한방사선의학회지 1984;20:45
  32. Sinner WN. Pulmonary neoplasms diagnosed with transthoracic needle biopsy. Cancer 1979;43:1533-40
  33. Sargent EN, Turner AF, Gordonson J, Schwinn CP, Pashky O. Percutaneous pulmonary needle biopsy: Report of 350 patients. Am J Roentgenol Radium Ther Nucl med 1974;122:758-68
  34. Westcott JL. Percutaneous transthoracic needle biopsy. Radiology 1988;169(3):593-601
  35. Berquist TH, Bailey PB, Cortese DA, Miller WE. Transthoracic needle biopsy: accuracy and complications in relation to location and type of lesion. Mayo Clin Proc 1980;55:475-81
  36. van Sonnenberg E, Casola G, Ho M, Neff CC, Varney RR, Wittich GR et al. Difficult thoracic lesions: CT-guided biopsy experience in 150 cases. Radiology 1988;167:457-61
  37. Cianci P, Posin JP, Simshak RR et al. Air embolism complicating percutaneous thin needle biopsy of lung. Chest 1987;92:749-51
  38. Poe RH, Kallay MC, Wicks CM, Odoroff CL. Predicting risk of peumothorax in needle biopsy of the lung. Chest 1984;85:232-5
  39. Miller KS, Fish GB, Stanley JH, Schabel SI. Prediction of pneumothorax rate in percutaneous needle aspiration of the lung. Chest 1988;93:742-5
  40. Zavala DC, Schoell JE. Ultrathin needle aspiration of the lung in infectious and malignant disease. Am Rev Respir Dis 1981;123:125-31
  41. Sinner WN. Complications of percutaneous transthoracic needle aspiration biopsy. Acta Radiol Diagn 1976;17:813-28
  42. 김상진, 박광주, 신형철, 권 량, 조병준, 오세정 등. 경피적 폐 세침 흡인 생검의 기흉 위험 요인. 대한방사선의학회지 1997;37:453-7
  43. Cormier Y, Laviolette M, Tardif A. Prevention of pneumothorax in needle lung biopsy by breathing 100 percent oxygen. Thorax 1980;35:37-41
  44. St. Louis EL, Hyland R, Gray RR, Hutcheon M, Jones D, Grosman H. Percutaneous needle biopsy of lung lesions. Chest 1984;86:940-1