Safety Evaluation Of CT-guided Percutaneous Lung Biopsy In Patients With Pulmonary Nodules Complicated By COPD

BackgroundCT-guided percutaneous transthoracic needle biopsy（CT-PTNB）is one of the important methods for pathological biopsy of lung space-occupying lesions.and specificity were greater than 90%.Chronic obstructive pulmonary disease（COPD）is an important influencing factor of CT-PTNB complicated with hemorrhage and pneumothorax.At present,there are few studies on the safety of CT-PTNB in patients with pulmonary nodules complicated by COPD,and the conclusions of the studies are still controversial.ObjectiveIn this study,the clinical data of patients with CT-PTNB in the Department of Respiratory Medicine,Puyang Oilfield General Hospital from April 2016 to April 2021 were collected to analyze the effect of CT-PTNB in patients with pulmonary nodules with COPD and those without COPD.To further explore the safety of CT-PTNB in patients with pulmonary nodules complicated by COPD.MethodsThe clinical data of patients undergoing CT-PTNB in the Respiratory Department of Puyang Oilfield General Hospital from 2016.04 to 2021.04 were retrospectively collected,including: factors affecting puncture（age,gender,emphysema,smoking index,pulmonary function,nodule size,patient position,puncture site,puncture depth）and puncture complications.Patients were screened according to the exclusion and inclusion criteria,and a total of 482 patients were included.The diagnosis of patients was verified according to the "Guidelines for the Diagnosis and Treatment of Chronic Obstructive Pulmonary Disease（2021 Revised Edition）",and then 482 patients were divided into non-COPD group and COPD group.The COPD group was divided into mild COPD group（FEV1%Pred≥80%）,moderate COPD group（50≤FEV1%Pred≤79）,and severe COPD group（30≤FEV1%）according to the percentage of FEV1 in the predicted value.Pred≤49)and COPD very severe group（FEV1%Pred<30）four groups,referred to as mild group,moderate group,severe group and very severe group.SPSS22.0 software was used for statistical analysis of the collected data.When the measurement data（patient age,puncture depth,nodule size,etc.）conformed to the normal distribution,they were expressed as（x±s）,and the comparison between groups was performed using one-way variance.For analysis,enumeration data（emphysema,pneumothorax,hemorrhage,etc.）were expressed as the number of cases and percentage（%）,and were compared by χ2 test.When P<0.05,the difference was considered to be statistically significant.All statistical analysis results were further analyzed and discussed in combination with clinical and experimental design to understand the safety of CT-guided percutaneous lung biopsy in patients with COPD.Results1.There were 309 cases in the non-COPD group,173 cases in the COPD group,58 cases in the mild group,56 cases in the moderate group,37 cases in the severe group,and22 cases in the extremely severe group.The average age,smoking index,male ratio,emphysema and the severity of emphysema in the COPD group were significantly higher than those in the non-COPD group（P<0.0001）.There were no significant differences in lung nodule size,puncture site,puncture depth and patient position between the COPD group and the non-COPD group（P>0.05）.2.CT-PTNB in COPD group was complicated with bleeding in 53 cases（30.64%）and pneumothorax in 52 cases（30.06%）.In the non-COPD group,CT-PTNB was complicated with bleeding in 33 cases（10.68%）and pneumothorax in 46 cases（14.89%）.The probability of pneumothorax and hemorrhage in COPD group was significantly higher than that in non-COPD group（P<0.05,P<0.05）.3.In COPD group,48 cases（27.75%）of mild hemorrhage occurred in CT-PTNB,5cases（2.89%）of moderate hemorrhage,and 0 cases（0.00%）of severe hemorrhage;43cases（24.86%）of mild pneumothorax occurred,moderate There were 7 cases（4.05%）of pneumothorax and 2 cases（1.16%）of severe pneumothorax.In the non-COPD group,32cases（10.23%）of mild hemorrhage occurred in 32 cases（10.23%）,1 case（0.32%）of moderate hemorrhage,and 0 case（0.00%）of severe hemorrhage;mild pneumothorax occurred in 39 cases（12.62%）of moderate pneumothorax There were 6 cases（1.94%）,0cases（0.00%）with severe pneumothorax,and 1 case（0.32%）with subcutaneous emphysema.The severity of hemorrhage and pneumothorax in the COPD group was higher than that in the non-COPD group（P<0.05,P<0.05）.4.There were 17 cases（29.31%）,17 cases（30.36%）,7 cases（18.92%）and 12 cases（54.55%）in mild,moderate,severe and very severe COPD groups.There were 17 cases（31.03%）,11 cases（19.64%）,10 cases（27.03%）and 13 cases（59.09%）of pneumothorax in mild,moderate,severe and very severe COPD groups.The probability of pneumothorax in extremely severe group was higher than that in moderate group,and the probability of bleeding in extremely severe group was higher than that in severe group（P < 0.05,P <0.05）.5.There were 1 case（1.72%）,0 case（0.00%）,1 case（2.70%）,and 0 case of severe pneumothorax in COPD mild group,moderate group,severe group and extremely severe group who underwent CT-PTNB,respectively.（0.00%）.No serious bleeding occurred in each COPD group who underwent CT-PTNB.6.There were no other serious complications such as needle tract transfer,air embolism,and death in each COPD group.Conclusions1.COPD is a risk factor for CT-PTNB complicated with bleeding and pneumothorax.2.CT-PTNB is relatively safe and feasible in patients with pulmonary nodules complicated by COPD,but patients with pulmonary nodules complicated by very severe COPD should be treated with caution.