SIR 2024
General IR
Xiao Wu, MD (she/her/hers)
Resident Physician
University of California, San Francisco
Financial relationships: Full list of relationships is listed on the CME information page.
Lynn Leng, BS
Medical Student
University of California San Francisco
Disclosure information not submitted.
Andrew Li, BS
Medical Student
University of California San Francisco
Disclosure information not submitted.
Hannah Anh, MD
Clinical Fellow
University of California San Francisco
Disclosure information not submitted.
Sayedomid Ebrahimzadeh, MD
Clinical Fellow
University of California San Francisco
Disclosure information not submitted.
Brett Elicker, MD
Professor of Clinical Radiology, Chief of Cardiac and Pulmonary Imaging
University of California San Francisco
Disclosure information not submitted.
Brian Haas, MD
Assistant Professor
University of California San Francisco
Disclosure information not submitted.
Yoo Jin Lee, MD
Assistant Professor
University of California San Francisco
Disclosure information not submitted.
Jonathan Liu, MD
Assistant Professor
University of California San Francisco
Disclosure information not submitted.
Jamie Schroeder, MD
Assistant Professor
University of California San Francisco
Disclosure information not submitted.
Shravan Sridhar, MD, MS
Assistant Professor
University of California San Francisco
Disclosure information not submitted.
Maya Vella, MD
Assistant Professor
University of California San Francisco
Disclosure information not submitted.
Thienkhai Vu, MD
Associate Professor
University of California San Francisco
Disclosure information not submitted.
Michael Kohn, MD
Professor
University of California, San Francisco
Disclosure information not submitted.
To investigate the effect of the rapid rollover technique on the risk of pneumothorax after CT-guided lung biopsy, which has been shown effective in prior retrospective studies {1, 2}.
Materials and Methods:
A prospective, multisite, randomized controlled trial (RCT) has been in progress since institutional review board approval (NCT05342675). All patients referred for CT-guided lung biopsy were reviewed. Those with target lesions most amenable to anterior or lateral approach were considered for inclusion, as posterior approach patients naturally roll over after biopsies. Exclusion criteria include subpleural nodules, intra-procedural chest tube placement, or pre-existing conditions intolerant to prone or lateral decubitus positions. Intervention arm patients who recovered in the recommended position for > 30 minutes were considered complete. The primary outcome was new or enlarging pneumothorax on post-biopsy chest radiographs, and secondary outcome was chest tube insertion rate. The two groups were compared with independent t-tests for continuous variable and χ2 tests for categorical variables. A p-value < 0.05 was considered significant.
Results:
Of the 342 patients screened, 71 patients met inclusion criteria, 45 patients enrolled so far, and 40 patients included in the outcome analysis due to lack of post-biopsy radiographs in 5 patients. Nineteen were randomized to intervention and 21 to control. The median age was 68.5 (interquartile range or IQR: 61.5-75) and 65 (IQR: 56.3 – 77.3) in intervention and control groups (p = 0.71). There were no significant differences in gender, smoking history, indication, morphology, history of radiation, or number of passes through the pleura or fissure.
The median nodule/mass size was 18 mm (IQR: 10 - 33) and 13.5 mm (IQR 10 – 29.3) in intervention and control groups (p = 0.51). The median needle-path length and needle-pleura angle was 30 mm (IQR: 20 - 39) and 66 degrees (IQR: 47 – 80) in the intervention arm, 26 mm (IQR 14 - 44) and 54 degrees (IQR: 40 – 81.8) in the control arm (p values of 0.93 and 0.58). The intention-to-treat (ITT) analysis showed significantly higher risk of new or enlarging pneumothorax (1/19 and 7/21 patients in intervention and control arms, p = 0.027). The 1 patient who developed pneumothorax in the intervention group was not able to complete the intervention. Only 2 patients required chest tubes, both from the control group (p = 0.17 and 0.20 by ITT and PP).
Conclusion:
This multisite RCT found that rapid rollover reduces the risk of new or enlarging pneumothorax after CT-guided lung biopsy.