Ultrathin fine-needle aspiration biopsy of the lung with transfissural approach: does it increase the risk of pneumothorax?

Objective: Transthoracic fine-needle aspiration is an accurate and safe method for diagnosis of pulmonary lesions, and pneumothorax is the most frequent complication of the procedure. Crossing a lung fissure during biopsy has been thought to increase the risk of pneumothorax, and the need to cross a fissure is considered a relative contraindication. The purpose of this study was to assess the incidence and clinical significance of pneumothorax during needle aspiration biopsy performed with a transfissural approach in comparison with biopsies in which a fissure was not crossed.
Materials and Methods: Retrospective review of the medical records of patients who underwent fluoroscopically guided transthoracic biopsy of pulmonary nodules with a 25-gauge needle yielded the cases of 107 consecutively registered patients (59 men, 48 women; mean age, 62 years). In 43 of the biopsies, the major fissure was crossed, and in 64 biopsies, the control procedures, the fissure was avoided. CT scans were assessed for lesion size and location, biopsy approach, length of needle path, number of needle punctures, and presence of emphysema.
Results: Pneumothorax occurred in 11 patients (25%) in the transfissural biopsy group and in 19 patients (30%) in the group in which the fissure was avoided (p = 0.64). Pneumothorax necessitated chest tube placement in two patients (5%) in the transfissural biopsy group and seven patients (11%) in the control group (p = 0.25). In both groups, emphysema in the needle path was associated with increased risk of pneumothorax (p < 0.01).
Conclusion: Transthoracic needle biopsy with an ultrathin needle that crosses a lung fissure can be safely performed without increasing the rate of pneumothorax or the need for chest tube insertion.