Pneumothorax, hemorrhage risks may outweigh benefits of pulmonary biopsy

Transthoracic needle biopsy of a pulmonary nodule often results in pneumothorax that requires chest-tube placement, a team of investigators has found.

Pulmonary nodules are found in up to 25% of people undergoing computed tomography (CT) of the chest, making the question of whether to perform biopsy increasingly common. To determine population-based estimates of risks for complications after transthoracic needle biopsy of a pulmonary nodule, researchers analyzed data from 15,865 adults who had undergone this procedure.

The risk for any pneumothorax was 15%, with 6.6% of all biopsies resulting in pneumothorax requiring a chest tube. Hemorrhage was rare, complicating only 1% of biopsies. However, 17.8% of patients with hemorrhage required a blood transfusion.

Complication risk was greatest among patients aged 60 to 69 years (as opposed to younger or older patients, smokers, and those with chronic obstructive pulmonary disease). Persons who experienced pneumothorax requiring a chest tube or hemorrhage had longer lengths of stay and were more likely to develop respiratory failure requiring mechanical ventilation than were patients without complications.

In their report for Annals of Internal Medicine (2011;155[3]:137-144), the investigators concluded that transthoracic needle biopsy for pulmonary nodule may be too risky for patients at low risk of cancer, those too frail to undergo cancer treatment, or those with a high risk of cancer who should proceed directly to surgery.

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