Lung Biopsy Risks More Prevalent Than Expected

Needle biopsy of suspicious lung nodules, initially detected by computerized tomography (CT) scans is not as benign as often thought, according to a new study.

Researchers at Boston University School of Medicine (BUMC; MA, USA) conducted a cross-sectional analysis of 15,865 adults who had transthoracic needle biopsy of a pulmonary nodule; the data were derived from the 2006 state ambulatory and state inpatient databases for California, Florida, Michigan, and New York. The percentage of biopsies complicated by hemorrhage, any pneumothorax, or pneumothorax requiring a chest tube, and adjusted odds ratios for these complications associated with various biopsy characteristics were calculated by using multivariate, population-averaged generalized estimating equations.

The results showed that although hemorrhage was rare, complicating only 1% of biopsies, 17.8% of the patients with hemorrhage required a blood transfusion. In contrast, the risk for any pneumothorax was 15%, and 6.6% of all biopsies resulted in pneumothorax requiring a chest tube. Compared with patients without complications, those who experienced hemorrhage or pneumothorax requiring a chest tube had longer lengths of stay and were more likely to develop respiratory failure requiring mechanical ventilation. Patients aged 60 to 69 years (as opposed to younger or older patients), smokers, and those with chronic obstructive pulmonary disease (COPD) had higher risk for complications. The study was published in the August 2, 2011, issue of the Annals of Internal Medicine.

“Before exposing patients to potential harm from CT-guided biopsy, physicians must ensure that patients understand the risks,” said lead author Renda Soylemez Wiener, MD, MPH. “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.”

Because pulmonary nodules are found in up to 25% of patients undergoing a CT of the chest, the question of whether or not to perform a biopsy is becoming increasingly common.

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