Percutaneous lung biopsy with pleural & parenchymal blood patching: Results and complications from 1112 core biopsies

Zlevor, Annie M; Mauch, Scott C; Knott, Emily A; Pickhardt, Perry J; Gettle, Lori Mankowski; Mao, Lu; Meyer, Cristopher A; Hartung, Michael P; Kim, David H; Lubner, Meghan G; Hinshaw, J Louis; Foltz, Marcia L; Ziemlewicz, Timothy J; Lee, Fred T

PURPOSE: To evaluate outcomes of CT fluoroscopy-guided core lung biopsies with emphasis on diagnostic yield, complications, and efficacy of parenchymal and pleural blood patching to avoid chest tube placement. METHODS: This is a single-center retrospective analysis of CT fluoroscopy-guided percutaneous core lung biopsies between 2006 and 2020. Parenchymal blood patching during introducer needle withdrawal was performed in 74% of cases as a preventative measure, and pleural blood patching was the primary salvage maneuver for symptomatic or growing pneumothorax in 60/83 (72.2%) of applicable cases. RESULTS: A total of 1029 patients underwent 1112 biopsies (532 men, mean age 66 years, 38.6% history of emphysema, lesion size=16.7 mm). The diagnostic yield was 93.6% (1032/1103). Fewer complications requiring intervention were observed in patients who had undergone parenchymal blood patching (5.7 vs. 14.2%, p<0.001). Further intervention was required in 83/182 pneumothorax cases including: 1) Pleural blood patch (5.4%, 60/1112), 2) chest tube placement without a pleural blood patch attempt (1.5%, 17/1112), and 3) simple aspiration (0.5%, 6/1112). Pleural blood patch as monotherapy was successful in 83.3% (50/60) without need for further intervention. The overall chest tube rate was 2.6% (29/1112). Emphysema was the only significant risk factor for complications requiring intervention (p=<0.001). CONCLUSION: Percutaneous CT fluoroscopy-guided core lung biopsies performed with standardized techniques provide excellent diagnostic yield and few serious complications. Parenchymal blood patching during introducer needle withdrawal decreased complications requiring intervention. Salvage pleural blood patching reduced the frequency of chest tube placement for pneumothorax.