Risk of complications after transthoracic needle biopsy: population analysis - PulmCCM
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.

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  2 Responses to “Risk of complications after transthoracic needle biopsy: population analysis”

  1. 66 (0.39%) of NLST participants with false positives underwent needle biopsies. Following are the numbers for all of the follow-ups for false positives:

    No invasive procedure (16596) (97.3%)
    Thoracotomy, thoraoscopy, or mediastinoscopy (164) (0.96%)
    Bronchoscopy (227) (1.33%)
    Needle Biopsy (66) (0.39%)
    Total invasive – (457) (2.68%)

    Please note the new recommended criteria for a positive with ACR LungRADS reduces false positives from 26% to 10%. Also, less invasive biopsy protocols are available, for example, Electromagnetic navigational bronchoscopy (ENB) with less than 2% risk of pneumothorax.

    Lung cancer is the leading cause of cancer deaths with a dismal 16.8% 5 year survival. LDCT screening will save more than 20,000 lives per year. In addition, smoking cessation rates for those in lung cancer screening programs are 3 times the rate in the general population resulting in even more lives saved. It’s time to make lung cancer screening widely available for the high risk population.


  2. Lets hope it is a false positive!

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