Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
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Impact of Respiratory Phase during Pleural Puncture on Complications in CT-Guided Percutaneous Lung Biopsy

CT 유도 경피 폐생검에서 흉막 천자 시 호흡 시기가 합병증에 미치는 영향

  • Ji Young Park (Department of Radiology, Busan Paik Hospital, Inje University College of Medicine) ;
  • Ji-Yeon Han (Department of Radiology, Busan Paik Hospital, Inje University College of Medicine) ;
  • Seok Jin Choi (Department of Radiology, Busan Paik Hospital, Inje University College of Medicine) ;
  • Jin Wook Baek (Department of Radiology, Busan Paik Hospital, Inje University College of Medicine) ;
  • Su Young Yun (Department of Radiology, Busan Paik Hospital, Inje University College of Medicine) ;
  • Sung Kwang Lee (Department of Thoracic and Cardiovascular Surgery, Busan Paik Hospital, Inje University College of Medicine) ;
  • Ho Young Lee (Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine) ;
  • SungMin Hong (Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine)
  • 박지영 (인제대학교 부산백병원 영상의학과) ;
  • 한지연 (인제대학교 부산백병원 영상의학과) ;
  • 최석진 (인제대학교 부산백병원 영상의학과) ;
  • 백진욱 (인제대학교 부산백병원 영상의학과) ;
  • 윤수영 (인제대학교 부산백병원 영상의학과) ;
  • 이성광 (인제대학교 부산백병원 심장혈관흉부외과) ;
  • 이호영 (인제대학교 부산백병원 호흡기알레르기내과) ;
  • 홍성민 (인제대학교 부산백병원 호흡기알레르기내과)
  • Received : 2023.08.03
  • Accepted : 2023.11.09
  • Published : 2024.05.01
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Abstract

Purpose This study investigated whether the respiratory phase during pleural puncture in CT-guided percutaneous transthoracic needle biopsy (PTNB) affects complications. Materials and Methods We conducted a retrospective review of 477 lung biopsy CT scans performed during free breathing. The respiratory phases during pleural puncture were determined based on the table position of the targeted nodule using CT scans obtained during free breathing. We compared the rates of complications among the inspiratory, mid-, and expiratory respiratory phases. Logistic regression analysis was performed to control confounding factors associated with pneumothorax. Results Among the 477 procedures, pleural puncture was performed during the expiratory phase in 227 (47.6%), during the mid-phase in 108 (22.6%), and during the inspiratory phase in 142 (29.8%). The incidence of pneumothorax was significantly lower in the expiratory puncture group (40/227, 17.6%; p = 0.035) and significantly higher in the mid-phase puncture group (31/108, 28.7%; p = 0.048). After controlling for confounding factors, expiratory-phase puncture was found to be an independent protective factor against pneumothorax (odds ratio = 0.571; 95% confidence interval = 0.360-0.906; p = 0.017). Conclusion Our findings suggest that pleural puncture during the expiratory phase may reduce the risk of pneumothorax during image guided PTNB.

목적 전산화단층촬영(이하 CT) 유도 경피 폐 생검에서 흉막 천자 시에 호흡 시기가 합병증 발생에 영향을 미치는지 조사하는 것이다. 대상과 방법 자유 호흡 중 시행된 폐 생검의 CT 스캔 477개를 후향적으로 검토하였다. 흉막 천자 시 호흡 시기는 자유 호흡 중 얻은 CT 영상에서 목표 결절의 table position의 차이로 분석 평가하였다. 세 가지 호흡 시기(흡기, 중간, 호기)에서의 합병증 발생률을 비교하였다. 기흉에 대한 교란변수를 통제하기 위해 로지스틱 회귀 분석을 하였다. 결과 477건의 시술 중에서 흉막 천자는 227건(47.6%)에서 호기, 108건(22.6%)에서 중기, 142건(29.8%)에서 흡기에서 시행되었다. 기흉 발생률은 호기에서 유의하게 낮았고(40/227, 17.6%; p = 0.035) 중기에서 유의하게 높았다(31/108, 28.7%; p = 0.048). 교란변수를 통제한 후, 호기 시 흉막 천자는 기흉에 대해 독립적인 보호 요인으로 작용하였다(오즈비 = 0.571; 95% 신뢰구간 = 0.360-0.906; p = 0.017). 결론 본 연구 결과는 이미지 유도하 경피적 폐 생검시 호기에서 흉막 천자를 시행하는 것이 기흉 발생률을 감소시킬 수 있음을 보여주었다.

Keywords

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