J Huazhong Univ Sci Technol [Med Sci] 35(2):278-282,2015 DOI 10.1007/s11596-015-1424-3 J Huazhong Univ Sci Technol［Med Sci］ 35(2):2015
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Risk Factors of Complications after CT-guided Percutaneous Needle Biopsy of Lumps Near Pulmonary Hilum* Zhong-yuan YIN (尹中元), Zhen-yu LIN (林振宇), Ye WANG (王 晔), Peng-cheng LI (李鹏程), Nan SHEN (沈 楠), Qiong WANG (王 琼), Ting YE (叶 挺), Zhen-wei ZOU (邹枕玮), Bian WU (吴 边), Kun-yu YANG (杨坤禹), Gang WU (伍 钢)# Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430023, China © Huazhong University of Science and Technology and Springer-Verlag Berlin Heidelberg 2015
Summary: The factors influencing the incidence of common complications (pneumothorax and pulmonary hemorrhage) of CT-guided percutaneous needle biopsy of lumps near pulmonary hilum were investigated. CT-guided percutaneous needle biopsy of lumps near pulmonary hilum was performed on 48 patients. The complications of pneumothorax and pneumorrhagia as well as the contributing factors were analyzed statistically. The major complications associated with CT-guided needle biopsy included pneumothorax (13 cases, 27.1%) and pulmonary hemorrhage (14 cases, 20.24%). 2 test revealed that pneumothorax was associated with the lesion size and depth of needle penetration, and pulmonary hemorrhage with the depth of needle penetration and needle retention time with a significant P value. Pneumothorax was observed in 7 cases (17.5%) out of 40 cases with diameter of mass greater than 3 cm, and in 6 cases (60%) out of 10 cases with depth of needle penetration greater than 4 cm. Additionally, pulmonary hemorrhage was identified in 12 cases (41.4%) out of 29 cases with needle retention time longer than 15 min, and pulmonary hemorrhage in 7 cases (70%) out of 10 cases with depth of needle penetration greater than 4 cm. CT-guided percutaneous needle biopsy of lumps near pulmonary hilum is safe and effective. The key factors to prevent the complications include correct evaluation of lesion size, depth of needle penetration and the needle retention time before the operation. Key words: biopsy, CT-guided; hilum; pneumothorax; pulmonary hemorrhage
Lung cancer is one of the most popular malignant tumors over the world and also has the highest mortality rate[1]. About 500 thousand persons are diagnosed as new lung cancer patients every year in China. All the treatments are based on successfully getting the tumor tissues and making a biopsy identification. The patients with masses located on hilum of lung always undergo the bronchofiberscope examinations if they have no surgery plan. For those who cannot tolerate this kind of examination or have already been checked by endoscopy but could hardly get a clear diagnosis, computed tomographic (CT)-guided percutaneous cord needle biopsy is recommended in our hospital. This paper reviews the advantages and complications of this kind biopsy of hilum lesions in our cancer center and discusses the anatomical and technical aspects and limitations of this technique. 1 MATERIALS AND METHODS 1.1 Patients’ Characteristics We evaluated the medical records of 48 patients who had undergone CT-guided biopsies of undiagnosed hilum lesions at our cancer center between October 2008 and August 2010. Of the 48 patients, 30 cases were male and 18 were female with an average age of 56 (39–73 years). The diameters of the mass were from 2.5 to 5.6
Zhong-yuan YIN, E-mail: [email protected] Corresponding author, E-mail: [email protected] * This project was supported by the National Natural Science Foundation of China (No. 81102074). #
cm. Informed consent was obtained from all patients. 1.2 Surgery Preparation All patients were subjected to blood routine examination, prothrombin time and activated partial thromboplastin time test, and electrocardiogram examination. Rough cough patients were treated with antitussive agents before the operation. Each patient routinely underwent breathholding training and CT scanning before the operation. Absolute contraindications included: (1) coagulation disorder; (2) high risk of large vessels damage around hilum; (3) uncontrollable rough cough. 1.3 CT-Guided Biopsy Technique Patients were placed in the supine or prone position. The instrument used was a coaxial biopsy system that comprised an 18-gauge introducer needle. Firstly, a plain scan of CT was performed. The best approach of puncture was chosen according to the target chosen, and a lead marker was placed. A second plain scan of CT was performed to verify the target. After the administration of local anesthesia, the introducer needle was gradually placed into the edge of the puncture target. The internal stylet was removed, and the biopsy needle was immediately replaced. The specimen was obtained by pressing the plunger, and the biopsy needle was removed followed by immediate replacement by the stylet of the introducer needle. After sufficient specimen was collected, the needle was quickly pulled out during breathholding. The specimen was fixed with 10% formaldehyde for further examination. 1.4 Postoperative Management A plain scan of CT was performed again 10 min to
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J Huazhong Univ Sci Technol［Med Sci］ 35(2):2015
30 min later to observe whether complications such as pneumothorax and/or pneumorrhagia existed. Patients received oxygen inhalation, sputum suction, manual aspiration and hemostatic treatment if necessary. 1.5 Statistical Analysis Analysis was made using the SPSS 10.0 statistical software package. The χ2 test was used for analysis of complications. P
278
Risk Factors of Complications after CT-guided Percutaneous Needle Biopsy of Lumps Near Pulmonary Hilum* Zhong-yuan YIN (尹中元), Zhen-yu LIN (林振宇), Ye WANG (王 晔), Peng-cheng LI (李鹏程), Nan SHEN (沈 楠), Qiong WANG (王 琼), Ting YE (叶 挺), Zhen-wei ZOU (邹枕玮), Bian WU (吴 边), Kun-yu YANG (杨坤禹), Gang WU (伍 钢)# Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430023, China © Huazhong University of Science and Technology and Springer-Verlag Berlin Heidelberg 2015
Summary: The factors influencing the incidence of common complications (pneumothorax and pulmonary hemorrhage) of CT-guided percutaneous needle biopsy of lumps near pulmonary hilum were investigated. CT-guided percutaneous needle biopsy of lumps near pulmonary hilum was performed on 48 patients. The complications of pneumothorax and pneumorrhagia as well as the contributing factors were analyzed statistically. The major complications associated with CT-guided needle biopsy included pneumothorax (13 cases, 27.1%) and pulmonary hemorrhage (14 cases, 20.24%). 2 test revealed that pneumothorax was associated with the lesion size and depth of needle penetration, and pulmonary hemorrhage with the depth of needle penetration and needle retention time with a significant P value. Pneumothorax was observed in 7 cases (17.5%) out of 40 cases with diameter of mass greater than 3 cm, and in 6 cases (60%) out of 10 cases with depth of needle penetration greater than 4 cm. Additionally, pulmonary hemorrhage was identified in 12 cases (41.4%) out of 29 cases with needle retention time longer than 15 min, and pulmonary hemorrhage in 7 cases (70%) out of 10 cases with depth of needle penetration greater than 4 cm. CT-guided percutaneous needle biopsy of lumps near pulmonary hilum is safe and effective. The key factors to prevent the complications include correct evaluation of lesion size, depth of needle penetration and the needle retention time before the operation. Key words: biopsy, CT-guided; hilum; pneumothorax; pulmonary hemorrhage
Lung cancer is one of the most popular malignant tumors over the world and also has the highest mortality rate[1]. About 500 thousand persons are diagnosed as new lung cancer patients every year in China. All the treatments are based on successfully getting the tumor tissues and making a biopsy identification. The patients with masses located on hilum of lung always undergo the bronchofiberscope examinations if they have no surgery plan. For those who cannot tolerate this kind of examination or have already been checked by endoscopy but could hardly get a clear diagnosis, computed tomographic (CT)-guided percutaneous cord needle biopsy is recommended in our hospital. This paper reviews the advantages and complications of this kind biopsy of hilum lesions in our cancer center and discusses the anatomical and technical aspects and limitations of this technique. 1 MATERIALS AND METHODS 1.1 Patients’ Characteristics We evaluated the medical records of 48 patients who had undergone CT-guided biopsies of undiagnosed hilum lesions at our cancer center between October 2008 and August 2010. Of the 48 patients, 30 cases were male and 18 were female with an average age of 56 (39–73 years). The diameters of the mass were from 2.5 to 5.6
Zhong-yuan YIN, E-mail: [email protected] Corresponding author, E-mail: [email protected] * This project was supported by the National Natural Science Foundation of China (No. 81102074). #
cm. Informed consent was obtained from all patients. 1.2 Surgery Preparation All patients were subjected to blood routine examination, prothrombin time and activated partial thromboplastin time test, and electrocardiogram examination. Rough cough patients were treated with antitussive agents before the operation. Each patient routinely underwent breathholding training and CT scanning before the operation. Absolute contraindications included: (1) coagulation disorder; (2) high risk of large vessels damage around hilum; (3) uncontrollable rough cough. 1.3 CT-Guided Biopsy Technique Patients were placed in the supine or prone position. The instrument used was a coaxial biopsy system that comprised an 18-gauge introducer needle. Firstly, a plain scan of CT was performed. The best approach of puncture was chosen according to the target chosen, and a lead marker was placed. A second plain scan of CT was performed to verify the target. After the administration of local anesthesia, the introducer needle was gradually placed into the edge of the puncture target. The internal stylet was removed, and the biopsy needle was immediately replaced. The specimen was obtained by pressing the plunger, and the biopsy needle was removed followed by immediate replacement by the stylet of the introducer needle. After sufficient specimen was collected, the needle was quickly pulled out during breathholding. The specimen was fixed with 10% formaldehyde for further examination. 1.4 Postoperative Management A plain scan of CT was performed again 10 min to
279
J Huazhong Univ Sci Technol［Med Sci］ 35(2):2015
30 min later to observe whether complications such as pneumothorax and/or pneumorrhagia existed. Patients received oxygen inhalation, sputum suction, manual aspiration and hemostatic treatment if necessary. 1.5 Statistical Analysis Analysis was made using the SPSS 10.0 statistical software package. The χ2 test was used for analysis of complications. P
