Hakan KILIÇ, Cüneyt ERDOGAN, Güven ÖZKAYA

Plevral Tabanlı Olmayan Akciğer Kitlelerinde Hidrojel Tıkaç Sistemi Etkinliği

Öz Amaç: Bu çalışma Bilgisayarlı Tomografi (BT) kılavuzluğunda yapılan plevral tabanlı olmayan akciğer biyopsilerinde gerçekleşen komplikasyonları ve hidrojel tıkama sisteminin bunları önleme yeteneğini değerlendirmek için yapılmıştır. Gereç ve yöntem: Plevral tabanlı olmayan akciğer kitle biyopsisi planlanan 46 vakaya BT eşliğinde koaksiyel sistemle biyopsi yapıldı. Takiben koaksiyel iğne çıkarılmadan hemen hidrojel tıkaç dokuya yerleştirildi. İşlem bitiminde ve 2 saat sonrasında biyopsi bölgesinde 5 cm’lik bir sahaya BT ile, 24 saat sonra akciğer grafisiyle kontrol edildi. Tek bir kontrolde bile saptanan pnömotorakslar pozitif sonuç olarak kabul edildi. Elde edilen veriler kitle boyutu, plevral mesafe, amfizem varlığı, yaş, sigara öyküsü, fissür geçme parametreleriyle literatür verileriyle karşılaştırılarak değerlendirildi. Bulgular: Çalışmada en çok saptanan komplikasyon 13 olgu (%26,5) ile pnömotoraks oldu. Bu olgulardan 1’ine (%2,04) toraks tüpü yerleştirildi. En yüksek pnömotoraks gelişme oranı 4 cm üstü (%33,3) lezyonlarda saptandı. Fissür geçilen olgularda 5 vakada (%71,4) pnömotoraks gerçekleşti. Pnömotoraks gelişen ve gelişmeyen hastalar yaşdeğişkeni açısından karşılaştırıldığında istatistiksel olarak anlamlı farklılık bulundu(p=0.048). Sonuç: Sonuçlara göre hidrojel tıkaç uygulamasının başarılı ve güvenli bir yöntem olduğunu göstermektedir. Pnömotoraks olguları analiz edildiğinde sadece bir olguda tüp drenajı gerektiren düzeyde masif pnömotoraks gelişmesi ve pnömotoraks yüzdesinin kabul edilebilir düzeyde olması yöntemin başarısı olarak kabul edilebilir.

Anahtar Kelimeler:

Pnömotoraks, Akciğer, Kitle, Biyopsi, Hidrojel

Efficiency of Hydrogel Plugging System in Non-Pleural Lung Masses

Objective: The aim of this study is to evaluate the complications of non-pleural-based lung biopsies performed under Computed Tomography (CT) guidance, and the ability of the hydrogel plugging system to prevent them. Material and method: Biopsy were performed in 49 cases with non-pleural-based lung mass with a coaxial system, accompanied by CT. Hydrogel plug was immediately inserted into the tissue without removing the coaxial needle. At the end of the procedure and 2 hours later, a 5 cm area in the biopsy area was controlled by CT, and 24 hours later by chest X-ray. Pneumothoraxes detected even in a single control were accepted as positive results. The data obtained were evaluated regarding the literature based on the parameters like mass size, pleural distance, presence of emphysema, age, smoking history, passing fissure. Results: Pneumothorax was the most encountered complication observed in 13 cases (26.5%) in the study. Thorax tube was placed in 1 of these cases (2.04 %). The highest rate of pneumothorax development was detected in lesions over 4 cm (33.3%) distance. In cases where fissure was passed, pneumothorax occurred in 5 (71.4%) patients. When patients with and without pneumothorax were compared in terms of age, a statistically significant difference was found (p = 0.048). Discussion: The results show that hydrogel plug application is a successful and safe method. When pneumothorax cases were analyzed, the development of massive pneumothorax requiring tube drainage in only one case and the acceptable percentage of pneumothorax can be considered as the success of the method.

Keywords:

Pneumothorax, Lung, Mass, Biopsy, Hydrogel,

PDF

___

1. Li H, Boiselle PM, Shepard JO, Trotman-Dickenson B, McCloud TC. Diagnostic accuracy and safety of CT-guided percutaneous needle aspiration biopsy of the lung: comparison of small and large pulmonary nodules. AJR 1996; 167: 105-109.
2. Harter LP, Moss AA, Goldberg HI, Gross BH. CT-guided fine- needle aspiraions for diagnosis of benign and malignant disease. AJR 1983;140: 363-367.
3. Daly B, Templeton PA. Real-time CT fluoroscopy: evolution of an interventional tool. Radiology 1999; 211: 309-15.
4. Arslan A. Perkütan transtorasik biyopsiler. Klinik Aktüel Tıp Dergisi 2005; 1: 1-8.
5. Chojniak R, Isberner RK, Viana LM, Liao Shin Yu LS, Aita AA, Soares FA. Computed tomography guided needle biopsy: experience from 1,300 procedures. Sao Paulo Med J 2006; 124: 10-4.
6. Topal U, Berkman YM. Effect of needle tract bleeding on occurrence of pneumothorax after transthoracic needle biopsy. Eur J Radiol 2005; 53: 495-9.
7. Sinner WN. Complications of percutaneous transthoracic needle aspiration biopsy. Acta Radiol 1976; 17: 813-28.
8. Kazerooni EA, Lim FT, Mikhail A, Martinez FJ. Risk of pneumothorax in CT-guided transthoracic needle aspiration biopsy of the lung. Radiology 1996; 198: 371-5.
9. Zaetta JM, Licht MO, Fisher JS, Avelar RL. A Lung Biopsy Tract Plug for Reduction of Postbiopsy Pneumothorax and Other Complications: Results of a Prospective, Multicenter, Randomized, Controlled Clinical Study. J Vasc Interv Radiol 2010; 21: 1235-43.
10. Westcott JL. Direct percutaneous needle aspiration of localized pulmonary lesions: results in 422 patients. Radiology 1980; 137: 31-5.
11. Khouri NF, Stitik FP, Erozan YS, Gupta PK, Kim WS, Scott WW Jr, Hamper UM, Mann RB, Eggleston JC, Baker RR. Transthoracic needle aspiration biopsy of benign and malignant lung lesions. AJR 1985; 144: 281-8.
12. Jackson R, Coffin LH, DeMeules JE, Miller DB, Dietrich P, Fairbank J. Percutaneous needle biopsy of pulmonary lesions. Am J Surg 1980; 139: 586-90.
13. Gibney RTN, Man GCW, King EG, leRiche J. Aspiration biopsy in the diagnosis of pulmonary disease. Chest 1981; 80: 300-3.
14. Stevens GM, Jackman J. Outpatient needle biopsy of the lung: its safety and utility. Radiology 1984; 151: 301-4.
15. Bungay HK, Berger J, Traill ZC, Gleeson FV. Pneumothorax post CT- guided lung biopsy: a comparison between detection on chest radiographs and CT. Br J Radiol 1999; 72: 1160-3.
16. Lang EK, Ghavami R, Schreiner VC, Archibald S, Ramirez J. Autologous blood clot seal to prevent pneumothorax at CT-guided lung biopsy. Radiology 2000; 216: 93–6.
17. Bourgouin PM, Shepard JA, McLoud TC, Spizarny DL, Dedrick CG. Transthoracic needle aspiration biopsy: evaluation of the blood patch technique. Radiology 1988; 166: 93–5.
18. Herman SJ, Weisbrod GL. Usefulness of the blood patch technique after transthoracic needle aspiration biopsy. Radiology 1990; 176: 395–7.
19. Petsas T, Siamblis D, Giannakenas C, Tepetes K, Dougenis D, Spiropoulos K, Fezoulidis I, Dimopoulos I. Fibrin glue for sealing the needle track in fine-needle percutaneous lung biopsy using a coaxial system: part II-clinical study. Cardiovasc Intervent Radiol 1995; 18: 378–82.
20. Engeler CE, Hunter DW, Castaneda- Zuniga W, Tashjian JH, Yedlicka JW, Amplatz K. Pneumothorax after lung biopsy: prevention with transpleural placement of compressed collagen foam plugs. Radiology 1992; 184: 787–9.
21. Yeow KM, Su IH, Pan KT, et al. Risk factors of pneumothorax and bleeding: multivariate analysis of 660 CT-guided coaxial cutting needle lung biopsies. Chest 2004; 126: 748-54.
22. Topal U, Ediz B. Transthoracic needle biopsy: factors effecting risk of pneumothorax. EJR 2003; 48: 263–7.
23. Geraghty PR, Kee ST, McFarlane G, et al. CT-guided transthoracic needle aspiration biopsy of pulmonary nodules: needle size and pneumothorax rate. Radiology 2003; 229: 475-81.
24. Yıldırım E, Kırbaş İ, Harman A CT-guided cutting needle lung biopsy using modified coaxial technique: Factors effecting risk of complications. EJR 2009; 70: 57–60.
25. Şenol A. Toraks kitlelerinde bilgisayarlı tomografi eşliğinde perkütan ko-aksiyal kesici iğne biyopsisi (uygulama, sonuçları ve komplikasyonların değerlendirilmesi) (Uzmanlık Tezi). Diyarbakır: Dicle Üniversitesi; 2006.
26. Cox JE, Chiles C, McManus CM, Aquino SL, Choplin RH. Transthoracic needle aspiration biopsy: variables that affect risk of pneumothorax. Radiology 1999; 212: 165–8.
27. Miller KS, Fish GB, Stanely JH, Schabel SI. Prediction of pneumothorax rate in percutaneous needle aspiration of the lung. Chest 1988; 93: 742–5.
28. Wescott JL. Percutaneous transthoracic needle biopsy. Radiology 1988; 169: 593-601.
29. Fish GD, Stanley JH, Miller KS, Schabel SI, Sutherland SE. Postbiopsy pneumothorax: estimating the risk by chest radiography and pulmonary function tests. AJR 1988; 150: 71–4.
30. Satoh S, Ohdama S, Matsubara O. CT-guided automated cutting needle biopsy by a combined method for accurate specific diagnosis of focal lung lesions. Radiation Medicine 2005; 23: 30–6.
31. Kandarpa K, Aruny JE. Interventional procedures of thoracic lesions. In: Kandarpa K, Machan L (eds). Handbook of interventional radiologic procedures. New York: Lippincott Williams&Wilkins; 2002. 278-302.