Disclaimer: The views expressed herein do not necessarily represent the views of the funding agencies, the Department of Veterans Affairs, or the U.S. government.
Acknowledgment: The authors thank Janice Weinberg, PhD, Boston University School of Medicine, for her voluntary statistical assistance and recognize the contribution of our colleagues in the Veterans Affairs Outcomes Group and the Center for Health Quality, Outcomes, and Economic Research, whose voluntary feedback enhanced both our thinking and the presentation of our results.
Grant Support: By career development award K07 CA138772 from the National Cancer Institute (Dr. Wiener) and by the Department of Veterans Affairs.
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M10-2560.
Reproducible Research Statement:Study protocol and data set: Available from Dr. Wiener (e-mail, rwiener@bu.edu). Statistical code: Not available.
Requests for Single Reprints: Renda Soylemez Wiener, MD, MPH, The Pulmonary Center, Boston University School of Medicine, 72 East Concord Street, R-304, Boston, MA 02118; e-mail, rwiener@bu.edu.
Current Author Addresses: Dr. Wiener: The Pulmonary Center, Boston University School of Medicine, 72 East Concord Street, R-304, Boston, MA 02118.
Drs. Schwartz, Woloshin, and Welch: Veterans Affairs Outcomes Group 111 B, Veterans Affairs Medical Center, 215 North Main Street, White River Junction, VT 05009.
Author Contributions: Conception and design: R.S. Wiener, L.M. Schwartz, S. Woloshin, H.G. Welch.
Analysis and interpretation of the data: R.S. Wiener, L.M. Schwartz, S. Woloshin, H.G. Welch.
Drafting of the article: R.S. Wiener.
Critical revision for important intellectual content: R.S. Wiener, L.M. Schwartz, S. Woloshin, H.G. Welch.
Final approval of the article: R.S. Wiener, L.M. Schwartz, S. Woloshin, H.G. Welch.
Statistical expertise: L.M. Schwartz, S. Woloshin, H.G. Welch.
Obtaining of funding: R.S. Wiener.
From Boston University School of Medicine, Boston, Massachusetts; Center for Health Quality, Outcomes, & Economic Research, Edith Nourse Rogers Memorial Veterans Affairs Hospital, Bedford, Massachusetts; Veterans Affairs Outcomes Group, Department of Veterans Affairs, White River Junction, Vermont; and Dartmouth Medical School, Hanover, New Hampshire.
Because pulmonary nodules are found in up to 25% of patients undergoing computed tomography of the chest, the question of whether to perform biopsy is becoming increasingly common. Data on complications after transthoracic needle lung biopsy are limited to case series from selected institutions.
To determine population-based estimates of risks for complications after transthoracic needle biopsy of a pulmonary nodule.
The 2006 State Ambulatory Surgery Databases and State Inpatient Databases for California, Florida, Michigan, and New York from the Healthcare Cost and Utilization Project.
15 865 adults who had transthoracic needle biopsy of a pulmonary nodule.
Percentage of biopsies complicated by hemorrhage, any pneumothorax, or pneumothorax requiring a chest tube, and adjusted odds ratios for these complications associated with various biopsy characteristics, calculated by using multivariate, population-averaged generalized estimating equations.
Although hemorrhage was rare, complicating 1.0% (95% CI, 0.9% to 1.2%) of biopsies, 17.8% (CI, 11.8% to 23.8%) of patients with hemorrhage required a blood transfusion. In contrast, the risk for any pneumothorax was 15.0% (CI, 14.0% to 16.0%), and 6.6% (CI, 6.0% to 7.2%) of all biopsies resulted in pneumothorax requiring a chest tube. Compared with patients without complications, those who experienced hemorrhage or pneumothorax requiring a chest tube had longer lengths of stay (P < 0.001) and were more likely to develop respiratory failure requiring mechanical ventilation (P = 0.020). Patients aged 60 to 69 years (as opposed to younger or older patients), smokers, and those with chronic obstructive pulmonary disease had higher risk for complications.
Estimated risks may be inaccurate if coding of complications is incomplete. The analyzed databases contain little clinical detail (such as information on nodule characteristics or biopsy pathology) and cannot indicate whether performing the biopsy produced useful information.
Whereas hemorrhage is an infrequent complication of transthoracic needle lung biopsy, pneumothorax is common and often necessitates chest tube placement. These population-based data should help patients and physicians make more informed choices about whether to perform biopsy of a pulmonary nodule.
Department of Veterans Affairs and National Cancer Institute.
Published: Ann Intern Med. 2011;155(3):137-144.
Utility of pleural effusion drainage in the ICU: An updated systematic review and META-analysis.