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Pneumothorax Incidence with Normal Saline Instillation for Sealing the Needle Track After Computed Tomography-Guided Percutaneous Lung Biopsy

  • Clinical Investigation
  • Non-Vascular Interventions
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Abstract

Purpose

To determine whether instillation of normal saline solution for sealing the needle track reduces incidence of pneumothorax and chest tube placement after computed tomography-guided percutaneous lung biopsy.

Materials and Methods

A total of 242 computed tomography-guided percutaneous lung biopsies performed at a single institution were retrospectively reviewed, including 93 biopsies in which the needle track was sealed by instillation of 3–5 ml of normal saline solution during needle withdrawal (water seal group) and 149 biopsies without sealing (control group). Patient and lesion characteristics, procedure-specific variables, pneumothorax and chest tube placement rates were recorded.

Results

Baseline characteristics were comparable in both groups. There was a statistically significant decrease in the pneumothorax rate (19.4% [18/93] vs. 40.9% [61/149]; p < 0.001) and a numerically lower chest tube placement rate without significant reduction (4.3% [4/93] vs. 10.7% [16/149]; p = 0.126) with using normal saline instillation for sealing the needle track versus not using sealant material. Using a multiple logistic regression analysis, using normal saline instillation to seal the needle track, having a senior radiologist as operator of the procedure and putting patients in prone position were significantly associated with a decreased risk of pneumothorax. The presence of emphysema along the needle track was significantly associated with an increased risk of pneumothorax. No complication was observed due to normal saline injection.

Conclusion

Normal saline solution instillation for sealing the needle track after computed tomography-guided percutaneous lung biopsy is a simple, low-cost and safe technique resulted in significantly decreased pneumothorax occurrence and a numerically lower chest tube placement rate, and might help to reduce both hospitalization risks and costs for the healthcare system.

Level of evidence 3 Non-controlled retrospective cohort study.

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Acknowledgements

The graphical abstract was partly generated using Servier Medical Art, provided by Servier, licensed under a Creative Commons Attribution 3.0 unported license.

Funding

This study was not supported by any funding.

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Authors and Affiliations

  1. Department of Radiology, Nantes University Hospital, 1 Place Alexis Ricordeau, 44093, Nantes, France

    Geoffrey Bourgeais, Eric Frampas, Renan Liberge, Aymeric Nicolas, Claire Defrance & Olivier Morla

  2. Department of Pneumology, Nantes University Hospital, Boulevard Jacques-Monod, 44093, Saint-Herblain, France

    François-Xavier Blanc

  3. Nantes Université, CHU Nantes, Pôle Hospitalo-Universitaire, 11: Santé Publique, Clinique Des Données, INSERM, CIC 1413, 44000, Nantes, France

    Sandrine Coudol

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  1. Geoffrey Bourgeais
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Appendix

Appendix

Incidence of pneumothorax and chest tube placement in studies using a sealant material.

Study

Pneumothorax

Chest tube placement

Sealant (%)

Control (%)

OR [95% CI]

Sealant (%)

Control (%)

OR [95% CI]

Normal saline

Billich [26]

6/70 (8.6%)

24/70 (34.3%)

0.18 [0.07–0.48]

1/70 (1.4%)

8/70 (11.4%)

0.11 [0.01–0.92]

Li [27]

10/161 (6.2%)

42/161 (26.1%)

0.19 [0.09–0.39]

1/161 (0.6%)

9/161 (5.6%)

0.11 [0.01–0.84]

Babu [28]

32/100 (32%)

46/100 (46%)

0.55 [0.31–0.98]

1/100 (1%)

7/100 (7%)

0.13 [0.02–1.11]

Tract plug

Engeler [19]

2/25 (8%)

7/25 (28%)

0.22 [0.04–1.21]

2/25 (8%)

2/25 (8%)

1 [0.13–7.72]

Petsas [18]

5/26 (19.2%)

13/32 (40.6%)

0.35 [0.10–1.16]

1/26 (3.8%)

6/32 (18.8%)

0.17 [0.02–1.54]

Zaetta [20]

30/170 (17.6%)

53/169 (31.4%)

0.47 [0.28–0.78]

6/170 (3.5%)

18/169 (10.7%)

0.31 [0.12–0.79]

Baadh [24]

11/125 (8.8%)

26/124 (21%)

0.36 [0.17–0.77]

5/125 (4%)

10/124 (8.1%)

0.48 [0.16–1.43]

Ahrar [21]

66/317 (20.8%)

104/317 (32.8%)

0.54 [0.38–0.77]

26/317 (8.2%)

66/317 (20.8%)

0.34 [0.21–0.55]

Grage [22]

29/100 (29%)

31/100 (31%)

0.91 [0.50–1.67]

2/100 (2%)

10/100 (10%)

0.18 [0.04–0.86]

Blood patch

Bourgouin [12]

15/52 (28.8%)

30/88 (34.1%)

0.85 [0.37–1.65]

4/52 (7.7%)

8/88 (9.1%)

0.83 [0.24–2.92]

Herman [13]

11/46 (23.9%)

14/47 (29.8%)

0.74 [0.30–1.86]

1/46 (2.2%)

1/47 (2.1%)

1.02 [0.06–16.8]

Lang [14]

5/50 (10%)

18/50 (36%)

0.20 [0.07–0.59]

0/50 (0%)

7/50 (14%)

0.06 [0.00–1.03]

Malone [15]

32/123 (26%)

42/119 (35.3%)

0.64 [0.37–1.12]

11/123 (8.9%)

21/119 (17.6%)

0.46 [0.21–1.00]

Clayton [34]

69/245 (28.2%)

80/189 (42.3%)

0.53 [0.36–0.80]

10/245 (4.1%)

30/189 (15.9%)

0.23 [0.11–0.47]

Graffy [16]

145/482 (30.1%)

154/352 (43.8%)

0.55 [0.42–0.74]

15/482 (3.1%)

24/352 (6.8%)

0.44 [0.23–0.85]

  1. OR Odds ratio.
  2. CI confidence interval.

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Bourgeais, G., Frampas, E., Liberge, R. et al. Pneumothorax Incidence with Normal Saline Instillation for Sealing the Needle Track After Computed Tomography-Guided Percutaneous Lung Biopsy. Cardiovasc Intervent Radiol 47, 604–612 (2024). https://doi.org/10.1007/s00270-023-03648-y

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