Short-duration post CT-guided thoracic biopsy monitoring- clinical experience with 440 patients

Post-CT-guided lung biopsy optimisation of the observation period by identifying patients at risk of delayed pneumothorax

INTRODUCTION

Identify the risk factors for delayed pneumothorax after lung biopsy.

METHODS

A retrospective study of 355 CT-guided lung biopsies was performed at Fiona Stanley Hospital, Western Australia over 42 months. A comprehensive range of patient, lesion and procedural variables were recorded. All post-procedural complications including time, size of pneumothorax and post-biopsy radiographs were reviewed. Lasso logistic regression model was utilised to determine factors predicting patient complications.

RESULTS

A total of 167 patients (47%) developed a pneumothorax, in which 34% were significant, requiring longer observation or drain insertion. The majority of pneumothoraces occurred within the first hour (86%), with 90% detected at the time of the procedure. Then, 12% were detected more than 3 h post-procedure, of which 8 patients (5%) had a significant delayed pneumothorax. Factors increasing the likelihood of significant pneumothorax include the length of lung traversed, smaller nodule size, surrounding emphysema, increased age and lateral patient position with the lesion in the non-dependent aspect. Increasing patient age, longer length of lung traversed and smaller nodule diameter increase the risk of delayed onset of pneumothorax (more than 3 h).

CONCLUSION

The results of this study align with other studies indicating it is safe to discharge stable patients within an hour post-lung biopsy. However, specific risk factors, including age, small lesion size and deep lesions, may identify patients who could benefit from a longer observation period.

One hour observation of patients after image-guided percutaneous renal mass biopsy

Background

Imaging-guided percutaneous biopsy of renal masses is regarded as safe and is widely used for histopathology diagnosis before treatment. Recommended observation time after tumour biopsy varies in international guidelines and the literature is sparse.

Purpose

To assess the effect of a 1-h post-biopsy observation time of percutaneous image-guided renal mass biopsy.

Material and Methods

This was a single-centre retrospective study. During January 2015 to September 2019, a total of 484 patients underwent renal mass biopsies. 4-h-observation-group: 178 patients and 1-h-observation-group 306 patients. All records were retrospectively reviewed, and data such as complications was obtained and compared between the two groups.

Results

A total complication rate of 4.5% ( n = 22) without any major complications (Cardiovascular and Interventional Radiological Society of Europe-grade (CIRSE) 5–6). Furthermore, a non-significant difference of 1.3% of the 1-h group and 3.4% in the 4-h group experiencing complications was found ( p = .18). A total biopsy-accuracy of 84% was observed.

Conclusion

This study shows that renal mass biopsy is safe with no major complications. This suggests that an outpatient approach with 1-h-observation time can be safely implemented for renal mass biopsy.

Retrospective evaluation of routine in-hospital observation in 433 patients after CT-guided biopsies

BACKGROUND

After computed tomography (CT)-guided interventions, routine in-hospital observation is recommended by the Cardiovascular and Interventional Radiological Society of Europe.

PURPOSE

To evaluate the frequency of delayed major complications or hospitalizations after CT-guided biopsies in patients with initially no or minor complications and to assess whether routine in-hospital observation is justified.

MATERIAL AND METHODS

This retrospective study included 433 outpatients after CT-guided biopsy of the thoracic (n = 176), abdominal (n = 129), or musculoskeletal (n = 128) region with subsequent in-hospital observation. Complications were graded according to the current Society of Interventional Radiology recommendations and grouped into minor or major. A complication that occurred during in-hospital observation was defined as delayed complication. A delayed major complication was a newly developed major complication or a progression from an initially minor to a major complication. Hospitalization frequencies were evaluated similarly. Occurrence, 95% confidence intervals (CI), and P values for significant differences between the three organ groups were calculated. If delayed major complications were more frequent than 1%, routine in-hospital observation was considered justified.

RESULTS

Delayed, major complication frequencies were: thoracic, 8.2% (95% CI 4.6-13.4); abdominal, 0.0% (95% CI 0.0-2.9); and musculoskeletal, 0.0% (95% CI 0.0-2.9) (P < 0.001). Delayed hospitalization frequencies were: thoracic, 8.8% (95% CI 5.0-14.2); abdominal, 1.6% (95% CI 0.2-5.6); and musculoskeletal, 0.0% (95% CI 0.0-2.9) (P < 0.001).

CONCLUSION

After thoracic interventions, routine observation is considered justified for patient safety whereas routine observation may be omitted after musculoskeletal interventions. In the abdominal group, no delayed complications were observed, but delayed hospitalization occurred. Thus, in-hospital observation could be justified in a safe patient environment, but remains an individual decision.

Short-duration post CT-guided thoracic biopsy monitoring- clinical experience with 440 patients

Purpose

With several studies recording a higher percentage of complications in the first hour of post‐biopsy, this study sought to evaluate the safety in the reduction in post‐biopsy patient monitoring time after computed tomography (CT)‐guided thoracic biopsies, providing a basis for further research.

Materials and Methods

This was a retrospective study involving patients who were referred to our centre for CT‐guided thoracic biopsies from January 2010 to December 2017. Patients who presented with no complications immediately after the post‐biopsy CT scan were given 30 min of post‐biopsy care after which they were discharged, and given a hot line to call in case of any complication. There was also a follow‐up call by a nurse after 24 h to inquire about any complication and general condition of the patients.

Results

A total of 440 core needle thoracic biopsies were performed within the period of the study. The most common thoracic region indicated for biopsy was mediastinal (n = 240, 54.5%), followed by lung (n = 185, 42.0%). Complications were recorded at a rate of 6.4% (n = 28), with 4.1% (n = 18) been pneumothorax and pulmonary haemorrhage and haemoptysis accounting for 2.3% (n = 10). No relevant complications were recorded in patients who presented with no complications immediately after the post‐biopsy CT scan (n = 374, 85%).

Conclusions

Findings from this initial study have shown that thirty minutes of post‐biopsy care could be sufficient for patients present with no complications immediately after a post‐procedural scan in CT‐guided thoracic biopsies; providing a basis for similar algorithms to be explored in a randomised control study to substantiate the observation.