Pneumothorax common after transthoracic lung biopsy, study finds

Patients who undergo transthoracic lung biopsy of a pulmonary nodule may be likely to develop pneumothorax, although hemorrhages are not common, a new study reports.

Researchers performed a cross-sectional analysis of the 2006 State Ambulatory Surgery Databases and State Inpatient Databases from the Healthcare Cost and Utilization Project in California, Florida, Michigan and New York, with the goal of determining population-based estimates of complication risks after transthoracic needle biopsy of a pulmonary nodule. The main outcome measures were percentages of biopsies followed by a hemorrhage, any pneumothorax, or pneumothorax requiring a chest tube, along with adjusted odds ratios by biopsy characteristic. The study results were published in the Aug. 2 Annals of Internal Medicine.

Data were analyzed for 15,865 adults who had transthoracic needle biopsy of a pulmonary nodule. Hemorrhages occurred in 1.0% of biopsies (95% CI, 0.9% to 1.2%), and of patients with hemorrhage, 17.8% (95% CI, 11.8% to 23.8%) required a blood transfusion. Pneumothorax occurred in 15.0% of patients (95% CI, 14.0% to 16.0%), and 6.6% (95% CI 6.0% to 7.2%) of all biopsies resulted in pneumothorax requiring a chest tube. Hemorrhage and pneumothorax with a chest tube were associated with longer lengths of stay (P<0.001) and respiratory failure requiring mechanical ventilation (P=0.020) compared with no complications. Risk for complications was higher in patients between 60 and 69 years of age compared with younger and older patients, as well as in patients who smoked and patients with chronic obstructive pulmonary disease.

The authors noted that the data they used cannot be linked to other sources to provide information on, for example, long-term risks and benefits, and that some complications may have been undercoded. However, they concluded that transthoracic biopsy of a pulmonary nodule may be associated with significant harms. “For many patients, including those with a low risk for cancer, those who are too frail to undergo cancer treatment, or those with a high risk for cancer who should proceed directly to surgery, this procedure may be unnecessary,” they wrote. “Before exposing patients to potential harm from [computed tomography]-guided biopsy, physicians must ensure that patients understand the risks.”