Percutaneous lung biopsy after pneumonectomy: Factors for improving success in the care of patients at high risk

Abstract

OBJECTIVE. The purpose of this study was to assess the risks and complications of CT-guided needle biopsy of lung nodules in patients with a single lung after pneumonectomy. MATERIALS AND METHODS. A database search for the records of patients who had undergone lung biopsy over a 9-year period revealed that 1771 patients had done so. Fourteen (0.7%) of these patients (11 men, three women; mean age, 63 years; range, 42.4-79.6 years) had undergone pneumonectomy and been referred for biopsy of the contralateral lung. The images and medical records of these patients were reviewed in detail. RESULTS. Lung biopsy was technically successful in 86% (12/14) of cases. All procedures were fine-needle aspiration, and a core biopsy specimen also was obtained in one case. Fifty percent (6/12) of the procedures were performed with local anesthesia alone and 50% with a combination of local anesthesia and conscious sedation. The pneumothorax rate was 25% (3/12). All pneumothoraces were small and asymptomatic, and none required a chest drain. There were no cases of hemoptysis. No other immediate or delayed complications were encountered. Malignancy was found in 83% (10/12) of cases. In one of the other two cases (8%) the result was false-negative, and in the other, the nodules resolved without chemotherapy and were presumed to be inflammatory. CONCLUSION. Percutaneous lung biopsy performed on the single lung in patients who have undergone pneumonectomy is feasible and successful. Lung biopsy in these circumstances should be performed by an experienced radiologist with thoracic surgical backup. © American Roentgen Ray Society.