Original ArticleUtilization of the track embolization technique to improve the safety of percutaneous lung biopsy and/or fiducial marker placement☆,☆☆
Introduction
Lung cancer is the third most common cancer in the United States and is the leading cause of cancer-related death, accounting for approximately 28% of all cancer-associated mortality [1], [2]. Death from lung cancer is often related to the initial stage at diagnosis, with the average 5-year survival rate being highest when the disease is diagnosed early [1], [2]. However, only 15% of lung cancer cases are diagnosed at an early enough stage to impact prognosis [1]. The most recent iteration of the United States Prevention Screening Task Force (USPSTF) lung cancer screening guidelines, updated in December of 2013, now recommends annual screening computed tomography (CT) of the chest for all adults between the ages of 55 and 80 who have a 30-pack-year or greater smoking history and who currently smoke or have quit smoking within the past 15 years [1], [2].
CT-guided percutaneous transthoracic core biopsy and/or fiducial marker placement have become widely accepted methods in establishing the etiology of lung masses/nodules and/or assisting in treatment [3]. The procedure is generally regarded as safe, with limited associated morbidity and extremely rare mortality [4], [5]. Among the complications, pneumothorax (PTX) remains the most frequent, with a minority requiring treatment with chest tube placement [4]. The frequency of PTX after CT-guided lung biopsy is variable in the literature, with reported rates ranging from 8% to 64% [4]. Furthermore, between 1.6% and 17% of these pneumothoraces require chest tube placement [6]. Treatment of PTX with chest tube drainage adds radiological costs (equipment, pre- and postprocedure imaging, professional fees, etc.), pharmacy expenses (fluids, anesthetic agents, etc.), nursing care, and hospitalization charges.
The purpose of our study was therefore to evaluate a new and simple technique for passive track embolization with the use of commonly available absorbable hemostat gelatin powder (Surgifoam, Ethicon, Somerville, NJ, USA) during percutaneous CT-guided lung biopsy and/or fiducial marker placement to reduce the rate of complications. This study compares the rate of iatrogenic PTX, chest tube placement, and minor and major hemorrhage rates in patients undergoing passive track embolization with a control group who did not receive track embolization. In addition, we evaluated the average cost per patient of this technique. To our knowledge, this specific technique and material have not been previously studied for CT-guided lung biopsy and/or fiducial marker placement.
Section snippets
Study design and study period
A single-institution, retrospective review of all CT-guided lung biopsies and/or fiducial marker placements was conducted in which 124 consecutive control patients were compared to 125 consecutive track embolization patients. The study included all patients who underwent percutaneous CT-guided lung biopsy and/or fiducial marker placement during the study period at our institution. One hundred twenty-four consecutive control patients underwent procedures (March 2007–August 2009), who were then
Results
A total of 124 consecutive control patients underwent CT-guided lung biopsy and/or fiducial placement and were then compared to 125 consecutive patients who underwent track embolization. Patient and procedure demographics are provided in Table 1. Adequate specimens were obtained in all patients with one pass through the pleura, and on-site cytopathology confirmed that all biopsies were sufficient in quality and quantity for analysis. All procedures were technically successful, with appropriate
Discussion
The updated USPSTF lung cancer screening guidelines place an emphasis on early detection, which will increase the role of the diagnostic and interventional radiologists in the diagnosis and management of lung cancer. Although percutaneous lung biopsy has been shown to be overall a safe technique, PTX is a known and frequently encountered complication. In practice, the frequency of PTX after CT-guided lung biopsy has been shown to widely vary, with documented rates as high as 64% [4]. Although
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