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Background <p>Pneumothorax requiring chest tube after CT-guided transthoracic lung biopsy presents added clinical risk and costs to the healthcare system. Identifying high-risk patients can prompt alternative biopsy modes and/or better preparation for more focused post-procedural care. We aimed to develop and externally validate a risk nomogram for pneumothorax requiring chest tube placement following CT-guided lung biopsy, leveraging quantitative emphysema algorithm.</p> Methods <p>This two-center retrospective study included patients who underwent CT-guided lung biopsy from between 1994 and 2023. Data from one hospital was set aside for validation (n = 613). Emphysema severity was quantified and categorized to 3-point scale using a previously published algorithm based on 3×3×3 kernels and Hounsfield thresholding, and a risk calculator was developed using forward variable selection and logistic regression. The model was validated using bootstrapping and Harrell’s C-index.</p> Results <p>2,512 patients (mean age, 64.47&#xa0;years ± 13.38 [standard deviation]; 1250 men) were evaluated, of whom 157 (6.7%) experienced pneumothorax complications requiring chest tube placement. After forward variable selection to reduce the covariates to maximize clinical usability, the risk score was developed using age over 60 (OR 1.80 [1.15–2.93]), non-prone patient position (OR 2.48 [1.63–3.75]), and severe emphysema (OR 1.99 [1.35–2.94]). The nomogram showed a mean absolute error of 0.5% in calibration and Harrell’s C-index of 0.664 in discrimination in the internal cohort.</p> Conclusion <p>The developed nomogram predicts age over 60, non-prone position during biopsy, and severe emphysema to be most predictive of pneumothorax requiring chest tube placement following CT-guided lung biopsy.</p>

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Development and validation of a risk nomogram predicting pneumothorax requiring chest tube placement post-percutaneous CT-guided lung biopsy

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年7月1日

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  • Masha Bondarenko,
  • Jianxiang Zhang,
  • Ulysis Hugo Baal Jr,
  • Brian Lam,
  • Gunvant Chaudhari,
  • Yoo Jin Lee,
  • Jamie Schroeder,
  • Maya Vella,
  • Brian Haas,
  • Thienkhai Vu,
  • Kimberly Kallianos,
  • Jonathan Liu,
  • Shravan Sridhar,
  • Brett Elicker,
  • Jae Ho Sohn

摘要

Background

Pneumothorax requiring chest tube after CT-guided transthoracic lung biopsy presents added clinical risk and costs to the healthcare system. Identifying high-risk patients can prompt alternative biopsy modes and/or better preparation for more focused post-procedural care. We aimed to develop and externally validate a risk nomogram for pneumothorax requiring chest tube placement following CT-guided lung biopsy, leveraging quantitative emphysema algorithm.

Methods

This two-center retrospective study included patients who underwent CT-guided lung biopsy from between 1994 and 2023. Data from one hospital was set aside for validation (n = 613). Emphysema severity was quantified and categorized to 3-point scale using a previously published algorithm based on 3×3×3 kernels and Hounsfield thresholding, and a risk calculator was developed using forward variable selection and logistic regression. The model was validated using bootstrapping and Harrell’s C-index.

Results

2,512 patients (mean age, 64.47 years ± 13.38 [standard deviation]; 1250 men) were evaluated, of whom 157 (6.7%) experienced pneumothorax complications requiring chest tube placement. After forward variable selection to reduce the covariates to maximize clinical usability, the risk score was developed using age over 60 (OR 1.80 [1.15–2.93]), non-prone patient position (OR 2.48 [1.63–3.75]), and severe emphysema (OR 1.99 [1.35–2.94]). The nomogram showed a mean absolute error of 0.5% in calibration and Harrell’s C-index of 0.664 in discrimination in the internal cohort.

Conclusion

The developed nomogram predicts age over 60, non-prone position during biopsy, and severe emphysema to be most predictive of pneumothorax requiring chest tube placement following CT-guided lung biopsy.