J Korean Soc Radiol.  2024 May;85(3):566-578. 10.3348/jksr.2023.0093.

Impact of Respiratory Phase during Pleural Puncture on Complications in CT-Guided Percutaneous Lung Biopsy

• Park JY
• Han JY
• Choi SJ
• Baek JW
• Yun SY
• Lee SK
• Lee HY
• Hong S

• KMID: 2556261
• DOI: http://doi.org/10.3348/jksr.2023.0093

Abstract

Purpose
This study investigated whether the respiratory phase during pleural puncture in CT-guided percutaneous transthoracic needle biopsy (PTNB) affects complications.
Materials and Methods
We conducted a retrospective review of 477 lung biopsy CT scans performed during free breathing. The respiratory phases during pleural puncture were determined based on the table position of the targeted nodule using CT scans obtained during free breathing. We compared the rates of complications among the inspiratory, mid-, and expiratory respiratory phases. Logistic regression analysis was performed to control confounding factors associated with pneumothorax.
Results
Among the 477 procedures, pleural puncture was performed during the expiratory phase in 227 (47.6%), during the mid-phase in 108 (22.6%), and during the inspiratory phase in 142 (29.8%). The incidence of pneumothorax was significantly lower in the expiratory puncture group (40/227, 17.6%; p = 0.035) and significantly higher in the mid-phase puncture group (31/108, 28.7%; p = 0.048). After controlling for confounding factors, expiratory-phase puncture was found to be an independent protective factor against pneumothorax (odds ratio = 0.571; 95% confidence interval = 0.360–0.906; p = 0.017).
Conclusion
Our findings suggest that pleural puncture during the expiratory phase may reduce the risk of pneumothorax during image guided PTNB.

Keyword

Image-Guided Biopsy; Needle Biopsy; Lung Neoplasm; Respiration