Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
권호 표지
DOI QR코드

DOI QR Code

Open Bronchus Sign on CT: A Risk Factor for Hemoptysis after Percutaneous Transthoracic Biopsy

  • Kim, Hyungjin (Department of Radiology, Seoul National University College of Medicine, and Institute of Radiation Medicine, Seoul National University Medical Research Center) ;
  • Park, Chang Min (Department of Radiology, Seoul National University College of Medicine, and Institute of Radiation Medicine, Seoul National University Medical Research Center) ;
  • Yoon, Soon Ho (Department of Radiology, Seoul National University College of Medicine, and Institute of Radiation Medicine, Seoul National University Medical Research Center) ;
  • Hwang, Eui Jin (Department of Radiology, Seoul National University College of Medicine, and Institute of Radiation Medicine, Seoul National University Medical Research Center) ;
  • Lee, Jong Hyuk (Department of Radiology, Seoul National University College of Medicine, and Institute of Radiation Medicine, Seoul National University Medical Research Center) ;
  • Ahn, Su Yeon (Department of Radiology, Seoul National University College of Medicine, and Institute of Radiation Medicine, Seoul National University Medical Research Center) ;
  • Goo, Jin Mo (Department of Radiology, Seoul National University College of Medicine, and Institute of Radiation Medicine, Seoul National University Medical Research Center)
  • Received : 2018.01.04
  • Accepted : 2018.03.01
  • Published : 2018.10.01
⟨ Previous Next ⟩

Abstract

Objective: We hypothesized that open bronchi within target pulmonary lesions are associated with percutaneous transthoracic needle biopsy (PTNB)-related hemoptysis. We sought to analyze and compare patient characteristics and target features as well as biopsy-related factors between patients with and without PTNB-related hemoptysis. Materials and Methods: We retrospectively analyzed 1484 patients (870 males and 614 females; median age, 66 years) who had undergone 1569 cone-beam CT (CBCT)-guided PTNBs. Patient characteristics (sex, age, and pathologic diagnosis), nodule features (nodule type, size, location, and presence of an open bronchus in target nodules), and biopsy-related factors (biopsy needle size, pleura-to-target distance, blood test results, open bronchus unavoidability [OBU] index, etc.) were investigated. OBU index, which was assessed using the pre-procedural CBCT, was a subjective scoring system for the probability of needle penetration into the open bronchus. Univariate analysis and subsequent multivariate logistic regression analysis were conducted to reveal the independent risk factors for PTNB-related hemoptysis. For a subgroup of nodules with open bronchi, a trend analysis between the occurrence of hemoptysis and the OBU index was performed. Results: The independent risk factors for hemoptysis were sex (female; odds ratio [OR], 1.918; p < 0.001), nodule size (OR, 0.837; p < 0.001), open bronchus (OR, 2.101; p < 0.001), and pleura-to-target distance (OR, 1.135; p = 0.003). For the target nodules with open bronchi, a significant trend between hemoptysis and OBU index (p < 0.001) was observed. Conclusion: An open bronchus in a biopsy target is an independent predictor of hemoptysis, and careful imaging review may potentially reduce PTNB-related hemoptysis.

Keywords

Acknowledgement

Supported by : Korea Health Industry Development Institute (KHIDI)

References

  1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2017. CA Cancer J Clin 2017;67:7-30 https://doi.org/10.3322/caac.21387
  2. Callister ME, Baldwin DR, Akram AR, Barnard S, Cane P, Draffan J, et al. British Thoracic Society guidelines for the investigation and management of pulmonary nodules. Thorax 2015;70 Suppl 2:ii1-ii54 https://doi.org/10.1136/thoraxjnl-2015-207168
  3. Ost DE, Gould MK. Decision making in patients with pulmonary nodules. Am J Respir Crit Care Med 2012;185:363-372 https://doi.org/10.1164/rccm.201104-0679CI
  4. Rotolo N, Floridi C, Imperatori A, Fontana F, Ierardi AM, Mangini M, et al. Comparison of cone-beam CT-guided and CT fluoroscopy-guided transthoracic needle biopsy of lung nodules. Eur Radiol 2016;26:381-389 https://doi.org/10.1007/s00330-015-3861-6
  5. Song YS, Park CM, Park KW, Kim KG, Lee HJ, Shim MS, et al. Does antiplatelet therapy increase the risk of hemoptysis during percutaneous transthoracic needle biopsy of a pulmonary lesion? AJR Am J Roentgenol 2013;200:1014-1019 https://doi.org/10.2214/AJR.12.8931
  6. Lee BE, Kletsman E, Rutledge JR, Korst RJ. Utility of endobronchial ultrasound-guided mediastinal lymph node biopsy in patients with non-small cell lung cancer. J Thorac Cardiovasc Surg 2012;143:585-590 https://doi.org/10.1016/j.jtcvs.2011.11.022
  7. Lee SM, Park CM, Lee KH, Bahn YE, Kim JI, Goo JM. C-arm cone-beam CT-guided percutaneous transthoracic needle biopsy of lung nodules: clinical experience in 1108 patients. Radiology 2014;271:291-300 https://doi.org/10.1148/radiol.13131265
  8. Wang Y, Jiang F, Tan X, Tian P. CT-guided percutaneous transthoracic needle biopsy for paramediastinal and nonparamediastinal lung lesions: diagnostic yield and complications in 1484 patients. Medicine (Baltimore) 2016;95:e4460 https://doi.org/10.1097/MD.0000000000004460
  9. Lim WH, Park CM, Yoon SH, Lim HJ, Hwang EJ, Lee JH, et al. Time-dependent analysis of incidence, risk factors and clinical significance of pneumothorax after percutaneous lung biopsy. Eur Radiol 2018;28:1328-1337 https://doi.org/10.1007/s00330-017-5058-7
  10. Choo JY, Park CM, Lee NK, Lee SM, Lee HJ, Goo JM. Percutaneous transthoracic needle biopsy of small ($\leq$ 1 cm) lung nodules under C-arm cone-beam CT virtual navigation guidance. Eur Radiol 2013;23:712-719 https://doi.org/10.1007/s00330-012-2644-6
  11. Jin KN, Park CM, Goo JM, Lee HJ, Lee Y, Kim JI, et al. Initial experience of percutaneous transthoracic needle biopsy of lung nodules using C-arm cone-beam CT systems. Eur Radiol 2010;20:2108-2115 https://doi.org/10.1007/s00330-010-1783-x
  12. Saba L, Montisci R, Raz E, Sanfilippo R, Suri JS, Piga M. Association between carotid artery plaque type and cerebral microbleeds. AJNR Am J Neuroradiol 2012;33:2144-2150 https://doi.org/10.3174/ajnr.A3133
  13. Khan MF, Straub R, Moghaddam SR, Maataoui A, Gurung J, Wagner TO, et al. Variables affecting the risk of pneumothorax and intrapulmonal hemorrhage in CT-guided transthoracic biopsy. Eur Radiol 2008;18:1356-1363 https://doi.org/10.1007/s00330-008-0893-1
  14. Tai R, Dunne RM, Trotman-Dickenson B, Jacobson FL, Madan R, Kumamaru KK, et al. Frequency and severity of pulmonary hemorrhage in patients undergoing percutaneous CT-guided transthoracic lung biopsy: single-institution experience of 1175 cases. Radiology 2016;279:287-296 https://doi.org/10.1148/radiol.2015150381
  15. Yeow KM, See LC, Lui KW, Lin MC, Tsao TC, Ng KF, et al. Risk factors for pneumothorax and bleeding after CT-guided percutaneous coaxial cutting needle biopsy of lung lesions. J Vasc Interv Radiol 2001;12:1305-1312 https://doi.org/10.1016/S1051-0443(07)61556-5
  16. Yildirim E, Kirbas I, Harman A, Ozyer U, Tore HG, Aytekin C, et al. CT-guided cutting needle lung biopsy using modified coaxial technique: factors effecting risk of complications. Eur J Radiol 2009;70:57-60 https://doi.org/10.1016/j.ejrad.2008.01.006
  17. Anzidei M, Sacconi B, Fraioli F, Saba L, Lucatelli P, Napoli A, et al. Development of a prediction model and risk score for procedure-related complications in patients undergoing percutaneous computed tomography-guided lung biopsy. Eur J Cardiothorac Surg 2015;48:e1-e6 https://doi.org/10.1093/ejcts/ezv172
  18. Cheng YC, Tsai SH, Cheng Y, Chen JH, Chai JW, Chen CC. Percutaneous transthoracic lung biopsy: comparison between C-arm cone-beam CT and conventional CT guidance. Transl Oncol 2015;8:258-264 https://doi.org/10.1016/j.tranon.2015.04.006
  19. Choi MJ, Kim Y, Hong YS, Shim SS, Lim SM, Lee JK. Transthoracic needle biopsy using a C-arm cone-beam CT system: diagnostic accuracy and safety. Br J Radiol 2012;85:e182-e187 https://doi.org/10.1259/bjr/95413532
  20. Jaconi M, Pagni F, Vacirca F, Leni D, Corso R, Cortinovis D, et al. C-arm cone-beam CT-guided transthoracic lung core needle biopsy as a standard diagnostic tool: an observational study. Medicine (Baltimore) 2015;94:e698 https://doi.org/10.1097/MD.0000000000000698
  21. Jiao de C, Li TF, Han XW, Wu G, Ma J, Fu MT, et al. Clinical applications of the C-arm cone-beam CT-based 3D needle guidance system in performing percutaneous transthoracic needle biopsy of pulmonary lesions. Diagn Interv Radiol 2014;20:470-474 https://doi.org/10.5152/dir.2014.13463
  22. Otto S, Mensel B, Friedrich N, Schafer S, Mahlke C, von Bernstorff W, et al. Predictors of technical success and rate of complications of image-guided percutaneous transthoracic lung needle biopsy of pulmonary tumors. PLoS One 2015;10:e0124947 https://doi.org/10.1371/journal.pone.0124947
  23. Choi JW, Park CM, Goo JM, Park YK, Sung W, Lee HJ, et al. C-arm cone-beam CT-guided percutaneous transthoracic needle biopsy of small ($\leq$ 20 mm) lung nodules: diagnostic accuracy and complications in 161 patients. AJR Am J Roentgenol 2012;199:W322-W330 https://doi.org/10.2214/AJR.11.7576

Cited by

  1. 2020 Clinical Practice Guideline for Percutaneous Transthoracic Needle Biopsy of Pulmonary Lesions: A Consensus Statement and Recommendations of the Korean Society of Thoracic Radiology vol.22, pp.2, 2021, https://doi.org/10.3348/kjr.2020.0137