The clinical data of 623 patients undergoing CT-guided percutaneous lung biopsy at Department of Respiratory Medicine, Xinqiao Hospital, Third Military Medical University from January 2010 to November 2012 were analyzed to examine the influencing factors for the occurrences of
pneumothorax and
hemoptysis, including patient age, gender, site of
puncture,
tumor location and size, depth and number of
puncture,
chronic obstructive pulmonary disease (
COPD) and doctor's clinical experience.
RESULTS: A total of 623 cases were recruited. There were 410 male and 213 female with an average age of 60 ± 11 (15-87) years. Among them, 618 were diagnosed as malignant lung
tumors with a positive rate of 99.2%. Pathological classifications were
adenocarcinoma (n = 387, 62.1%),
squamous carcinoma (n = 166, 26.6%),
small cell lung cancer (
n = 30, 4.8%), undifferentiated
cancer (n = 18, 2.9%)
adenosquamous carcinoma (n = 2, 0.3%), sarcomatoid
carcinoma (n = 6, 0.9%),
leiomyosarcoma (n = 3, 0.5%),
neuroendocrine carcinoma (n = 2, 0.3%), low differentiated
carcinoid (n = 1, 0.2%),
cribriform carcinoma (n = 1, 0.2%),
malignant lymphoma (n = 1, 0.2%) and metastatic
renal cell carcinoma (n = 1, 0.2%) respectively. Another 5 patients (0.8%) had an initial diagnosis of chronic
inflammation according to their pathological features of lung
punctures. Their definite diagnoses were lung
squamous cell carcinoma (n = 3),
adenocarcinoma (n = 1) and
small cell carcinoma (n = 1) respectively. The major complications were
pneumothorax and
hemoptysis. Among 73 cases of
pneumothorax (n = 73, 11.7%), 65 cases (n = 65, 10.4%) of mild
pneumothorax (lung compression < 20%) were cured by sufficient
oxygen inhalation and repose while 8 cases (1.3%) suffered lung compression ≥ 75% recovered via closed thoracic drainage. Eighty-four patients (13.5%) suffered from the complications of slight or self-limited
hemoptysis with blood-tinged sputum. The symptoms of
hemoptysis disappeared after oral
hemostatic or other treatments. Another 5 patients (0.8%) suffered from moderate
hemoptysis (100-500 ml) and their symptoms disappeared after rest or an
intravenous infusion of haemostatic. None of them died of massive
hemoptysis or biopsy. The occurrence of
pneumothorax was significantly correlated with the diameter of lesions ( ≤ 2 cm) (P = 0.006), depth of needle (>3 cm) (P = 0.044), number of
puncture needles ( ≥ 3 needles) (P = 0.025), inadequate clinical experience of puncturing doctors (P = 0.003) and
COPD (P = 0.036); the occurrence of
hemoptysis was obviously correlated with the diameter of lesions ( ≤ 2 cm) (P = 0.031), depth of needle (>3 cm) (P = 0.018), number of
puncture needles ( ≥ 3 needles) (P = 0.015) and inadequate clinical experience of puncturing doctors (P = 0.014). However, the relationship was unremarkable between the occurrences of
pneumothorax and
hemoptysis and patient gender, age, sites of
puncture and
tumor location.
CONCLUSION: