Nov 012011

25% of smokers undergoing chest CT have incidentally discovered pulmonary nodules. As questions of national policy re: lung cancer screening with chest CT are considered, Soylemez Wiener et al report the complication rates of 15,865 adults who had transthoracic needle biopsy of a pulmonary nodule in 4 states over the past decade, using a database of insurance claims:

  • Pneumothorax: 15%
  • Pneumothorax requiring chest tube: 6.6%
  • Hemorrhage: 1% (requiring transfusion: 0.18%)

Patients getting a scheduled biopsy had a 0.1% risk for respiratory failure and a ~0.5% chance of dying in the hospital. Even those suffering a pneumothorax and chest tube only had a 0.7% chance of respiratory failure.

But patients undergoing biopsy while already hospitalized had >4% chance of dying in-hospital, and a 1-3% chance of respiratory failure.

The quality of this analysis is of course dependent on the accuracy of the ICD-9 coding -- which was probably good for these clinically important and billable outcomes.

Although seriously bad outcomes were uncommon among outpatients, if you're thinking in terms of screening, you're subjecting a huge number of essentially healthy people to these risks, as well as to the discomfort of "nonserious" pneumothoraces and chest tubes. (Remember that 40% of the >25,000 screened with CT in the Lung Cancer Screening Trial had a positive CT scan during the study, and 95% were false positives). I don't recall how many or what percentage in the NLST went for needle biopsy and their complication rates. Does anyone know this?

Ann Intern Med 2011;155:137-144.

Liked this post? Get a weekly email update, and explore our library of clinical guidelines, practice updatesreview articles. and board review questions.

PulmCCM is an independent publication not affiliated with or endorsed by any other organization, society or journal referenced on the website. (Terms of Use | Privacy Policy)

Authors: contribute your work in a guest post.


Risk of complications after transthoracic needle biopsy: population analysis