J. Louis Hinshaw MD, Abstract Co-Author: Stockholder, NeuWave Medical Inc Medical Advisory Board, NeuWave Medical Inc Stockholder, Cellectar Biosciences, Inc

Scott Bissell Loomis MD, Abstract Co-Author: Nothing to Disclose

Meghan G. Lubner MD, Abstract Co-Author: Nothing to Disclose

Timothy J. Ziemlewicz MD, Presenter: Nothing to Disclose

Perry J. Pickhardt MD, Abstract Co-Author: Co-founder, VirtuoCTC, LLC Stockholder, Cellectar Biosciences, Inc

Fred T. Lee MD, Abstract Co-Author: Stockholder, NeuWave Medical, Inc Patent holder, NeuWave Medical, Inc Board of Directors, NeuWave Medical, Inc Patent holder, Covidien AG Inventor, Covidien AG Royalties, Covidien AG

Douglas Robert Kitchin MD, Abstract Co-Author: Nothing to Disclose

David H. Kim MD, Abstract Co-Author: Consultant, Viatronix, Inc Co-founder, VirtuoCTC, LLC Medical Advisory Board, Digital ArtForms, Inc

There have been multiple smaller studies evaluating the role of an intraparenchymal blood patch (IPB) during lung biopsy, but they have shown mixed results and controversy remains as to the true efficacy of this technique. Therefore, the purpose of this study was to determine whether an autologous IBP reduces the rate of pneumothorax-related complications during CT-guided lung biopsies.

We reviewed all CT-guided lung biopsies performed between Aug 2006 and Sept 2013. Patients were excluded if no aerated lung was crossed. Data collected included: Number of pneumothoracies, and number of pneumothoracies requiring intervention (all catheter placements), as well as more advanced interventions (e.g. chest tube placement and hospital admission or pleural blood patch). The patients were assigned to two groups. Those that received an IBP and those that did not. The rate of pneumothorax, intervention, and advanced intervention were compared between the two groups.

839 patients were included in the study. Patients that received an IBP had a significantly decreased rate of pneumothorax, pneumothorax-related intervention, and advanced intervention ((142/482) 29% vs (154/357) 43%, p<0.0001; (45/482) 9.3% vs (87/354) 24.4%, p<0.0001; (38/482) 7.9% vs (78/357) 21.8%, p<0.0001 respectively) as compared to those that did not. Because of the success of a pleural blood patch for obviating the need for chest tube placement and hospital admission in our practice, the benefit of an IPB is less obvious when making this direct comparison (15/482 (3.1%) vs 16/357 (4.5%), p=0.35).

Autologous IPB placement is associated with a decreased rate of pneumothorax, and, more importantly, pneumothorax requiring intervention after CT-guided lung biopsies. Although this benefit has not resulted in a significant decrease in chest tube placement and hospital admission in our practice, this can be accounted for by the success of a pleural blood patch in obviating the need for hospital admission for many of these patients.

Autologous IPB placement has remained somewhat controversial due to mixed results in published series, but this large series confirms that there is a benefit, with a decreased rate of pneumothorax, and, more importantly, pneumothorax requiring intervention after CT-guided lung biopsies.

Hinshaw, J, Loomis, S, Lubner, M, Ziemlewicz, T, Pickhardt, P, Lee, F, Kitchin, D, Kim, D, Does an Intra-parenchymal Blood Patch Decrease the Rate of Pneumothorax-related Complications in Patients Undergoing Image-guided Lung Biopsy?.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14013463.html