Usual Interstitial Pneumonia: Associations With Complications After Percutaneous Transthoracic Needle Lung Biopsy

Background: Changes in lung parenchyma elasticity in usual interstitial pneumonia (UIP) may increase the risk for complications after percutaneous transthoracic needle lung biopsy (PTNB). Objective: To investigate the association of UIP findings on CT with complications after PTNB, including pneumothorax, pneumothorax requiring chest tube insertion, and hemoptysis. Methods: This retrospective single-center study included 4187 patients (mean age, 63.8±11.9 years; 2513 men, 1674 women) who underwent PTNB between January 2010 and December 2015. Patients were categorized into a UIP group and non-UIP group by review of preprocedural CT. In the UIP group, procedural CT images were reviewed to assess for traversal by the needle of UIP findings. Multivariable logistic regression analyses were performed to identify associations between UIP group and needle traversal with post-biopsy complications, controlling for a range of patient, lesion, and procedural characteristics. Results: The UIP and non-UIP groups included 148 and 4039 patients, respectively; in the UIP group, traversal by needle of UIP findings was observed in 53 patients and not observed in 95 patients. UIP group, in comparison with non-UIP group, had higher frequency of pneumothorax (35.1% vs 17.9%, p<.001) and pneumothorax requiring chest tube placement (6.1% vs 1.5%, p=.001), and lower frequency of hemoptysis (2.0% vs 6.1%, p=.03). In multivariable analyses, UIP group with traversal by needle of UIP findings, relative to non-UIP group, showed independent associations with pneumothorax (OR: 5.25; 95% CI: 2.94, 9.37; p<.001) and pneumothorax requiring chest tube placement (OR: 9.55; 95% CI: 3.74, 24.38; p<.001). UIP group without traversal by needle of UIP findings, relative to non-UIP group, was not independently associated with pneumothorax (OR: 1.18, 95% CI: 0.71, 1.97; p=.51) or pneumothorax requiring chest tube placement (OR: 1.08, 95% CI: 0.25, 4.72; p=.92). UIP group, with or without traversal by needle of UIP findings, was not independently associated with hemoptysis. No patient experienced air embolism or procedure-related death. Conclusion: Needle traversal of UIP findings is a risk factor for pneumothorax and pneumothorax requiring chest tube placement after PTNB. Clinical Impact: When performing PTNB in patients with UIP, radiologists should plan a needle trajectory that does not traverse UIP findings, when possible.