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

Affiliations
  • 1Department of Radiology, Seoul National University College of Medicine, and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul 03080, Korea. cmpark.morphius@gmail.com
  • 2Cancer Research Institute, Seoul National University, Seoul 03080, Korea.
  • 3Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Korea.

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*
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