Hemorrhagic Adverse Events of Transthoracic Needle Biopsy of the Lung in Patients with Pulmonary Hypertension: A Systematic Review and Meta-AnalysisPercutaneous

Daniel Jang; Rachel Darling; Gaurav Choudhary; Matthew Jankowich

doi:10.1016/j.jvir.2024.04.015

Hemorrhagic Adverse Events of Transthoracic Needle Biopsy of the Lung in Patients with Pulmonary Hypertension: A Systematic Review and Meta-AnalysisPercutaneous

J Vasc Interv Radiol. 2024 Apr 27:S1051-0443(24)00319-1. doi: 10.1016/j.jvir.2024.04.015. Online ahead of print.

Authors

Daniel Jang¹, Rachel Darling², Gaurav Choudhary³, Matthew Jankowich⁴

Affiliations

¹ Department of Medicine, Alpert Medical School of Brown University. Electronic address: danielhjang@gmail.com.
² Division of Pulmonary, Critical Care and Sleep Medicine, Alpert Medical School of Brown University.
³ Division of Cardiology, Providence VA Medical Center and Alpert Medical School of Brown University.
⁴ Division of Pulmonary and Critical Care Medicine, Providence VA Medical Center and Alpert Medical School of Brown University.

PMID: 38685471
DOI: 10.1016/j.jvir.2024.04.015

Abstract

Purpose: To compare the risk of hemorrhagic complications of transthoracic needle biopsy such as pulmonary hemorrhage and hemoptysis between patients with pulmonary hypertension and patients without pulmonary hypertension.

Materials and methods: Database search and citation review of search results were performed for studies reporting frequency of hemorrhagic complications of transthoracic needle biopsy in adult patients with evidence of pulmonary hypertension compared to patients undergoing the procedure without evidence of pulmonary hypertension. Random-effects meta-analysis was performed for both rates of pulmonary hemorrhage and hemoptysis.

Results: A total of 5 studies (encompassing n = 6250 patients who underwent 6684 biopsies) were included. All studies were retrospective and used CT or echocardiography for determination of pulmonary hypertension. Biopsy-related pulmonary hemorrhage was diagnosed radiographically and post-biopsy hemoptysis by documentation in the medical record. There were no differences found between patients with evidence of pulmonary hypertension and those without in regard rates of pulmonary hemorrhage (OR = 1.12 [0.85, 1.47] in studies that used CT to define PH, OR = 0.88 [0.56, 1.39] in studies that used echocardiography to define PH) or hemoptysis (OR = 0.95 [0.46, 1.97]).

Conclusions: A systematic review and meta-analysis of the literature did not demonstrate that patients with indirect evidence of pulmonary hypertension undergoing transthoracic needle biopsy had an increased risk of hemorrhagic complications.