Korean J Radiol.  2018 Oct;19(5):880-887. 10.3348/kjr.2018.19.5.880.

Open Bronchus Sign on CT: A Risk Factor for Hemoptysis after Percutaneous Transthoracic Biopsy

• Kim H
• Park CM
• Yoon SH
• Hwang EJ
• Lee JH
• Ahn SY
• Goo JM

• KMID: 2418551
• DOI: http://doi.org/10.3348/kjr.2018.19.5.880

Abstract

OBJECTIVE
We hypothesized that open bronchi within target pulmonary lesions are associated with percutaneous transthoracic needle biopsy (PTNB)-related hemoptysis. We sought to analyze and compare patient characteristics and target features as well as biopsy-related factors between patients with and without PTNB-related hemoptysis.
MATERIALS AND METHODS
We retrospectively analyzed 1484 patients (870 males and 614 females; median age, 66 years) who had undergone 1569 cone-beam CT (CBCT)-guided PTNBs. Patient characteristics (sex, age, and pathologic diagnosis), nodule features (nodule type, size, location, and presence of an open bronchus in target nodules), and biopsy-related factors (biopsy needle size, pleura-to-target distance, blood test results, open bronchus unavoidability [OBU] index, etc.) were investigated. OBU index, which was assessed using the pre-procedural CBCT, was a subjective scoring system for the probability of needle penetration into the open bronchus. Univariate analysis and subsequent multivariate logistic regression analysis were conducted to reveal the independent risk factors for PTNB-related hemoptysis. For a subgroup of nodules with open bronchi, a trend analysis between the occurrence of hemoptysis and the OBU index was performed.
RESULTS
The independent risk factors for hemoptysis were sex (female; odds ratio [OR], 1.918; p < 0.001), nodule size (OR, 0.837; p < 0.001), open bronchus (OR, 2.101; p < 0.001), and pleura-to-target distance (OR, 1.135; p = 0.003). For the target nodules with open bronchi, a significant trend between hemoptysis and OBU index (p < 0.001) was observed.
CONCLUSION
An open bronchus in a biopsy target is an independent predictor of hemoptysis, and careful imaging review may potentially reduce PTNB-related hemoptysis.

Keyword

Lung neoplasms; Image-guided biopsy; Cone-beam computed tomography; Hemoptysis; Risk factors; Open bronchus

MeSH Terms

Biopsy*
Biopsy, Needle
Bronchi*
Cone-Beam Computed Tomography
Female
Hematologic Tests
Hemoptysis*
Humans
Image-Guided Biopsy
Logistic Models
Lung Neoplasms
Male
Needles
Odds Ratio
Retrospective Studies
Risk Factors*

Figure

• 

  Fig. 1 OBU index. A. 1 (none): single open bronchus (arrow) in tumor periphery. B. 2 (low): multiple open bronchi in tumor periphery with adequate room to advance cutting needle into tumor. C. 3 (possible): centrally (arrow) and peripherally located open bronchi in tumor with space to advance cutting needle into tumor while evading open bronchi. D. 4 (probable): it is possible that open bronchi (arrows) in tumor are injured or penetrated by cutting needle. E. 5 (high): it is highly likely that open bronchi in tumor are penetrated by cutting needle. OBU = open bronchus unavoidability

• 

  Fig. 2 77-year-old male with invasive mucinous adenocarcinoma demonstrating extensive open bronchi. A. Extensive open bronchi (arrows) were observed on axial CT scan, and OBU index was 5 (high). B. Biopsy needle penetrated open bronchi, and patient had immediate hemoptysis following core biopsy.

• 

  Fig. 3 63-year-old male with invasive adenocarcinoma showing open bronchus. A. Open bronchus (arrow; OBU index, 3) was noted within tumor, connected to central airway. B. Therefore, inferior portion of tumor, which was solid and without patent bronchus, was targeted. Pre-procedural imaging evaluation and needle path planning facilitated prevention of hemoptysis.

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