J. Louis Hinshaw MD, Presenter: 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, 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

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

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

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

Although it is a commonly held belief that patients with emphysema are at increased risk for pneumothorax-related complications during lung biopsy, there is a paucity of data on the subject to determine if this is actually true, and if so, the magnitude of the increase in risk. This can make it difficult to accurately assess the risk vs the benefit of performing these procedures in patients with significant emphysema. The purpose of this study was to determine whether there is an association between emphysema and the number and severity of pneumothorax-related complications encountered during CT-guided percutaneous lung biopsies.

We reviewed all CT-guided lung biopsies performed between August 2006 and September 2013. Patients were excluded if no aerated lung was crossed. All other patients were included. Data collected included: number of pneumothoracies, number of pneumothoracies requiring an intervention (e.g. temporary catheter placement for aspiration or pleural blood patch placement), and number of pneumothoracies requiring chest tube placement and hospital admission. Presence of underlying emphysema along the biopsy path was recorded as none, mild, moderate or severe.

835 total patients were included in the study. The pneumothorax rate, rate of pneumothoraces requiring an intervention, and rate of pneumothoraces requiring chest tube placement and hospital admission were significantly higher in patients with moderate to severe emphysema as compared to those with none to mild emphysema ((86/194) 44.3% vs (212/641) 33.1%, p=0.005; (50/194) 25.8% vs (78/641) 12.2%, p=0.0001; and (19/194) 9.8% vs (20/641) 3.1%, p=0.0003, respectively)).

Moderate to severe emphysema is associated with a significantly increased rate of pneumothorax-related complications during percutaneous lung biopsies. More specifically, moderate to severe emphysema is associated with an ~2.5 times higher rate of pneumothorax-related complication requiring intervention and an ~3 times higher rate of chest tube placement and hospital admission. Understanding the magnitude of these risks will allow improved decision making and informed consent for these patients.

This study provides an objective measure of the increased risk of lung biopsy in patients with emphysema, and thus promotes improved decision making and informed consent for these patients.

Hinshaw, J, Loomis, S, Lubner, M, Ziemlewicz, T, Kim, D, Pickhardt, P, Kitchin, D, Lee, F, Patients with Emphysema: What is the Actual Risk of Pneumothorax-related Complications for these Patients during Percutaneous Lung Biopsies?.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14045659.html