CHEST Guidelines-Transthoracic-Needle-Biopsy-for-Pleural-and-Periph

Transthoracic-Needle-Biopsy-for-Pleural-and-Periph

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The correspondence from Wenjie Liang, Xianyong Zhou, and Shunliang Xu published in CHEST addresses Hallifax et al.'s study on ultrasound-guided biopsies for pleural lesions, highlighting its advantages over CT scan-guided procedures. The authors, with extensive experience in CT scan-guided biopsies, acknowledge the risks of pneumothorax and bleeding associated with imaging-guided biopsies. They mention that while CT imaging can help assess these risks preoperatively, the incidence of pneumothorax remains a concern, particularly in patients with emphysema and small lesions. <br /><br />According to Hallifax et al., no occurrences of pneumothorax were reported, whereas in other studies, such as Sconfienza et al., the incidences were 5.8% for ultrasound-guided and 14.7% for CT scan-guided procedures. Liang et al. state their center experienced a 20% pneumothorax rate with CT-guided procedures, significantly higher than Hallifax et al.'s results, yet within the 9% to 54% range reported in a recent review. Given the lower complication rates, they suggest that ultrasound guidance could be more favorable for pleural and peripheral lung lesion biopsies.<br /><br />The authors critique Hallifax et al.'s omission of emphysema assessment and note that thoracoscopy failures in certain cases were not explained, underscoring that emphysema is a significant risk factor for pneumothorax. They argue that postoperative observation should extend to 24 hours to monitor for delayed pneumothorax, rather than the 1-hour observation period that is standard practice. The correspondence ends with an emphasis on the need for further patient data elaboration regarding clinical features associated with the risk of pneumothorax.

Keywords

ultrasound-guided biopsies

CT scan-guided procedures

pneumothorax risk

pleural lesions

emphysema assessment

biopsy complications

thoracoscopy failures

postoperative observation

clinical features

imaging-guided biopsies