Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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2020 Clinical Practice Guideline for Percutaneous Transthoracic Needle Biopsy of Pulmonary Lesions: A Consensus Statement and Recommendations of the Korean Society of Thoracic Radiology

  • Soon Ho Yoon (Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Sang Min Lee (Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Chul Hwan Park (Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Jong Hyuk Lee (Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Hyungjin Kim (Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Kum Ju Chae (Department of Radiology, Institute of Medical Science, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital) ;
  • Kwang Nam Jin (Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center) ;
  • Kyung Hee Lee (Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Jung Im Kim (Department of Radiology, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University) ;
  • Jung Hee Hong (Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Eui Jin Hwang (Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Heekyung Kim (Department of Radiology, Eulji University College of Medicine, Eulji University Hospital) ;
  • Young Joo Suh (Department of Radiology, Severance Hospital, Yonsei University College of Medicine) ;
  • Samina Park (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Young Sik Park (Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Dong-Wan Kim (Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Miyoung Choi (National Evidence-based Healthcare Collaborating Agency) ;
  • Chang Min Park (Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine)
  • Received : 2020.02.17
  • Accepted : 2020.07.02
  • Published : 2021.02.01
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Abstract

Percutaneous transthoracic needle biopsy (PTNB) is one of the essential diagnostic procedures for pulmonary lesions. Its role is increasing in the era of CT screening for lung cancer and precision medicine. The Korean Society of Thoracic Radiology developed the first evidence-based clinical guideline for PTNB in Korea by adapting pre-existing guidelines. The guideline provides 39 recommendations for the following four main domains of 12 key questions: the indications for PTNB, pre-procedural evaluation, procedural technique of PTNB and its accuracy, and management of post-biopsy complications. We hope that these recommendations can improve the diagnostic accuracy and safety of PTNB in clinical practice and promote standardization of the procedure nationwide.

Keywords

Acknowledgement

The authors would like to acknowledge Andrew Dombrowski, PhD (Compecs, Inc.) for his assistance in improving the use of English in this manuscript.

References

  1. Lalli AF, Naylor B, Whitehouse WM. Aspiration biopsy of thoracic lesions. Thorax 1967;22:404-407  https://doi.org/10.1136/thx.22.5.404
  2. Manhire A, Charig M, Clelland C, Gleeson F, Miller R, Moss H, et al. Guidelines for radiologically guided lung biopsy. Thorax 2003;58:920-936  https://doi.org/10.1136/thorax.58.11.920
  3. National Lung Screening Trial Research Team, Aberle DR, Adams AM, Berg CD, Black WC, Clapp JD, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med 2011;365:395-409  https://doi.org/10.1056/NEJMoa1102873
  4. Balata H, Fong KM, Hendriks LE, Lam S, Ostroff JS, Peled N, et al. Prevention and early detection for NSCLC: advances in thoracic oncology 2018. J Thorac Oncol 2019;14:1513-1527  https://doi.org/10.1016/j.jtho.2019.06.011
  5. Pastorino U, Silva M, Sestini S, Sabia F, Boeri M, Cantarutti A, et al. Prolonged lung cancer screening reduced 10-year mortality in the MILD trial: new confirmation of lung cancer screening efficacy. Ann Oncol 2019;30:1162-1169  https://doi.org/10.1093/annonc/mdz117
  6. Reck M, Rabe KF. Precision diagnosis and treatment for advanced non-small-cell lung cancer. N Engl J Med 2017;377:849-861  https://doi.org/10.1056/NEJMra1703413
  7. Jo Y, Han DH, Beck KS, Park JS, Kim TJ. Practice pattern of transthoracic needle biopsy: 2016 survey in the members of Korean Society of Thoracic Radiology. Korean J Radiol 2017;18:1005-1011  https://doi.org/10.3348/kjr.2017.18.6.1005
  8. Lee C, Guichet PL, Abtin F. Percutaneous lung biopsy in the molecular profiling era: a survey of current practices. J Thorac Imaging 2017;32:63-67  https://doi.org/10.1097/RTI.0000000000000237
  9. Tavare AN, Hare SS, Miller FNA, Hammond CJ, Edey A, Devaraj A. A survey of UK percutaneous lung biopsy practice: current practices in the era of early detection, oncogenetic profiling, and targeted treatments. Clin Radiol 2018;73:800-809  https://doi.org/10.1016/j.crad.2018.05.009
  10. Choi SJ, Jeong WK, Jo AJ, Choi JA, Kim MJ, Lee M, et al. Methodology for developing evidence-based clinical imaging guidelines: joint recommendations by Korean Society of Radiology and National Evidence-based healthcare Collaborating Agency. Korean J Radiol 2017;18:208-216  https://doi.org/10.3348/kjr.2017.18.1.208
  11. Chen Y, Yang K, Marusic A, Qaseem A, Meerpohl JJ, Flottorp S, et al. A reporting tool for practice guidelines in health care: the RIGHT statement. Ann Intern Med 2017;166:128-132  https://doi.org/10.7326/M16-1565
  12. Gould MK, Donington J, Lynch WR, Mazzone PJ, Midthun DE, Naidich DP, et al. Evaluation of individuals with pulmonary nodules: when is it lung cancer? Diagnosis and management of lung cancer, 3rd ed: American college of chest physicians evidence-based clinical practice guidelines. Chest 2013;143:e93S-e120S 
  13. Callister ME, Baldwin DR, Akram AR, Barnard S, Cane P, Draffan J, et al. British thoracic society guidelines for the investigation and management of pulmonary nodules. Thorax 2015;70 Suppl 2:ii1-ii54  https://doi.org/10.1136/thoraxjnl-2015-207168
  14. McWilliams A, Tammemagi MC, Mayo JR, Roberts H, Liu G, Soghrati K, et al. Probability of cancer in pulmonary nodules detected on first screening CT. N Engl J Med 2013;369:910-919  https://doi.org/10.1056/NEJMoa1214726
  15. Detterbeck FC, Lewis SZ, Diekemper R, Addrizzo-Harris D, Alberts WM. Executive summary: diagnosis and management of lung cancer, 3rd ed: American college of chest physicians evidence-based clinical practice guidelines. Chest 2013;143(5 Suppl):7S-37S  https://doi.org/10.1378/chest.12-2377
  16. MacMahon H, Naidich DP, Goo JM, Lee KS, Leung ANC, Mayo JR, et al. Guidelines for management of incidental pulmonary nodules detected on CT images: from the fleischner society 2017. Radiology 2017;284:228-243  https://doi.org/10.1148/radiol.2017161659
  17. Wiener RS, Schwartz LM, Woloshin S, Welch HG. Population-based risk for complications after transthoracic needle lung biopsy of a pulmonary nodule: an analysis of discharge records. Ann Intern Med 2011;155:137-144  https://doi.org/10.7326/0003-4819-155-3-201108020-00003
  18. Rivera MP, Mehta AC, Wahidi MM. Establishing the diagnosis of lung cancer: diagnosis and management of lung cancer, 3rd ed: American college of chest physicians evidence-based clinical practice guidelines. Chest 2013;143(5 Suppl):e142Se165S 
  19. Scottish Intercollegiate Guidelines Network (SIGN). Lung cancer: diagnosis and management. Sign.ac.uk. Web site. https://www.sign.ac.uk/media/1075/sign137.pdf. Published February, 2014. Accessed October 26, 2020 
  20. Planchard D, Popat S, Kerr K, Novello S, Smit EF, Faivre-Finn C, et al. Metastatic non-small cell lung cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2018;29 Suppl 4:iv192-iv237  https://doi.org/10.1093/annonc/mdy275
  21. Lee SM, Park CM, Goo JM, Lee CH, Lee HJ, Kim KG, et al. Transient part-solid nodules detected at screening thin-section CT for lung cancer: comparison with persistent partsolid nodules. Radiology 2010;255:242-251  https://doi.org/10.1148/radiol.09090547
  22. Austin JH, Garg K, Aberle D, Yankelevitz D, Kuriyama K, Lee HJ, et al. Radiologic implications of the 2011 classification of adenocarcinoma of the lung. Radiology 2013;266:62-71  https://doi.org/10.1148/radiol.12120240
  23. Chae KJ, Hong H, Yoon SH, Hahn S, Jin GY, Park CM, et al. Non-diagnostic results of percutaneous transthoracic needle biopsy: a meta-analysis. Sci Rep 2019;9:12428 
  24. Lee SM, Park CM, Song YS, Kim H, Kim YT, Park YS, et al. CT assessment-based direct surgical resection of part-solid nodules with solid component larger than 5 mm without preoperative biopsy: experience at a single tertiary hospital. Eur Radiol 2017;27:5119-5126  https://doi.org/10.1007/s00330-017-4917-6
  25. National Institute for Health and Clinical Excellence. The diagnosis and treatment of lung cancer (update). Clinical guideline 121 [CG121]. Guidance.nice.org. Web site. http://guidance.nice.org.uk/CG121. Published April 21, 2011. Accessed October, 26 2020 
  26. El-Deiry WS, Goldberg RM, Lenz HJ, Shields AF, Gibney GT, Tan AR, et al. The current state of molecular testing in the treatment of patients with solid tumors, 2019. CA Cancer J Clin 2019;69:305-343  https://doi.org/10.3322/caac.21560
  27. Hsu JC, Wei CF, Yang SC. Effects of removing reimbursement restrictions on targeted therapy accessibility for non-small cell lung cancer treatment in Taiwan: an interrupted time series study. BMJ Open 2019;9:e022293 
  28. Jekunen AP. Role of rebiopsy in relapsed non-small cell lung cancer for directing oncology treatments. J Oncol 2015;2015:809835 
  29. Solomon SB, Zakowski MF, Pao W, Thornton RH, Ladanyi M, Kris MG, et al. Core needle lung biopsy specimens: adequacy for EGFR and KRAS mutational analysis. AJR Am J Roentgenol 2010;194:266-269  https://doi.org/10.2214/AJR.09.2858
  30. Yoon HJ, Lee HY, Lee KS, Choi YL, Ahn MJ, Park K, et al. Repeat biopsy for mutational analysis of non-small cell lung cancers resistant to previous chemotherapy: adequacy and complications. Radiology 2012;265:939-948  https://doi.org/10.1148/radiol.12112613
  31. Tokaca N, Barth S, O'Brien M, Bhosle J, Fotiadis N, Wotherspoon A, et al. Molecular adequacy of image-guided rebiopsies for molecular retesting in advanced non-small cell lung cancer: a single-center experience. J Thorac Oncol 2018;13:63-72  https://doi.org/10.1016/j.jtho.2017.09.1958
  32. Kim H, Chae KJ, Yoon SH, Kim M, Keam B, Kim TM, et al. Repeat biopsy of patients with acquired resistance to EGFR TKIs: implications of biopsy-related factors on T790M mutation detection. Eur Radiol 2018;28:861-868  https://doi.org/10.1007/s00330-017-5006-6
  33. Nam BD, Kim TJ, Park K, Ahn MJ, Choi YL, Chung MJ, et al. Transthoracic rebiopsy for mutation analysis in lung adenocarcinoma: outcomes and risk factors for the acquisition of nondiagnostic specimens in 199 patients. Clin Lung Cancer 2019;20:e309-e316  https://doi.org/10.1016/j.cllc.2018.12.021
  34. Tsai EB, Pomykala K, Ruchalski K, Genshaft S, Abtin F, Gutierrez A, et al. Feasibility and safety of intrathoracic biopsy and repeat biopsy for evaluation of programmed cell death ligand-1 expression for immunotherapy in non-small cell lung cancer. Radiology 2018;287:326-332  https://doi.org/10.1148/radiol.2017170347
  35. Kim L, Tsao MS. Tumour tissue sampling for lung cancer management in the era of personalised therapy: what is good enough for molecular testing? Eur Respir J 2014;44:1011-1022  https://doi.org/10.1183/09031936.00197013
  36. Kim H, Kwon D, Yoon SH, Kim H, Park CM, Goo JM, et al. Bronchovascular injury associated with clinically significant hemoptysis after CT-guided core biopsy of the lung: radiologic and histopathologic analysis. PLoS One 2018;13:e0204064 
  37. Anzidei M, Porfiri A, Andrani F, Di Martino M, Saba L, Catalano C, et al. Imaging-guided chest biopsies: techniques and clinical results. Insights Imaging 2017;8:419-428  https://doi.org/10.1007/s13244-017-0561-6
  38. Mahammedi A, Oshmyansky A, Hassoun PM, Thiemann DR, Siegelman SS. Pulmonary artery measurements in pulmonary hypertension: the role of computed tomography. J Thorac Imaging 2013;28:96-103  https://doi.org/10.1097/RTI.0b013e318271c2eb
  39. Tai R, Dunne RM, Trotman-Dickenson B, Jacobson FL, Madan R, Kumamaru KK, et al. Frequency and severity of pulmonary hemorrhage in patients undergoing percutaneous CT-guided transthoracic lung biopsy: single-institution experience of 1175 cases. Radiology 2016;279:287-296  https://doi.org/10.1148/radiol.2015150381
  40. Hwang EJ, Park CM, Yoon SH, Lim HJ, Goo JM. Risk factors for haemoptysis after percutaneous transthoracic needle biopsies in 4,172 cases: focusing on the effects of enlarged main pulmonary artery diameter. Eur Radiol 2018;28:1410-1419  https://doi.org/10.1007/s00330-017-5101-8
  41. Khouri NF, Stitik FP, Erozan YS, Gupta PK, Kim WS, Scott WW Jr, et al. Transthoracic needle aspiration biopsy of benign and malignant lung lesions. AJR Am J Roentgenol 1985;144:281-288  https://doi.org/10.2214/ajr.144.2.281
  42. Chaffey MH. The role of percutaneous lung biopsy in the workup of a solitary pulmonary nodule. West J Med 1988;148:176-181 
  43. Cronin CG, Sharma A, Digumarthy SR, Gilman MD, McLoud T, Muse VV, et al. Percutaneous lung biopsy after pneumonectomy: factors for improving success in the care of patients at high risk. AJR Am J Roentgenol 2011;196:929-934  https://doi.org/10.2214/AJR.10.4920
  44. Richardson CM, Pointon KS, Manhire AR, Macfarlane JT. Percutaneous lung biopsies: a survey of UK practice based on 5444 biopsies. Br J Radiol 2002;75:731-735  https://doi.org/10.1259/bjr.75.897.750731
  45. Tomiyama N, Yasuhara Y, Nakajima Y, Adachi S, Arai Y, Kusumoto M, et al. CT-guided needle biopsy of lung lesions: a survey of severe complication based on 9783 biopsies in Japan. Eur J Radiol 2006;59:60-64  https://doi.org/10.1016/j.ejrad.2006.02.001
  46. Yoon SH, Park CM, Lee KH, Lim KY, Suh YJ, Im DJ, et al. Analysis of complications of percutaneous transthoracic needle biopsy using CT-guidance modalities in a multicenter cohort of 10568 biopsies. Korean J Radiol 2019;20:323-331  https://doi.org/10.3348/kjr.2018.0064
  47. Patel IJ, Davidson JC, Nikolic B, Salazar GM, Schwartzberg MS, Walker TG, et al. Consensus guidelines for periprocedural management of coagulation status and hemostasis risk in percutaneous image-guided interventions. J Vasc Interv Radiol 2012;23:727-736  https://doi.org/10.1016/j.jvir.2012.02.012
  48. Patel IJ, Rahim S, Davidson JC, Hanks SE, Tam AL, Walker TG, et al. Society of interventional radiology consensus guidelines for the periprocedural management of thrombotic and bleeding risk in patients undergoing percutaneous image-guided interventions-part II: recommendations: endorsed by the canadian association for interventional radiology and the cardiovascular and interventional Radiological Society of Europe. J Vasc Interv Radiol 2019;30:1168-1184.e1  https://doi.org/10.1016/j.jvir.2019.04.017
  49. Hwang EJ, Kim H, Park CM, Yoon SH, Lim HJ, Goo JM. Cone beam computed tomography virtual navigation-guided transthoracic biopsy of small (≤ 1 cm) pulmonary nodules: impact of nodule visibility during real-time fluoroscopy. Br J Radiol 2018;91:20170805 
  50. Pinstein ML, Scott RL, Salazar J. Avoidance of negative percutaneous lung-biopsy using contrast-enhanced CT. AJR Am J Roentgenol 1983;140:265-267  https://doi.org/10.2214/ajr.140.2.265
  51. Guralnik L, Rozenberg R, Frenkel A, Israel O, Keidar Z. Metabolic PET/CT-guided lung lesion biopsies: impact on diagnostic accuracy and rate of sampling error. J Nucl Med 2015;56:518-522  https://doi.org/10.2967/jnumed.113.131466
  52. Purandare NC, Kulkarni AV, Kulkarni SS, Roy D, Agrawal A, Shah S, et al. F-18-FDG PET/CT-directed biopsy: does it offer incremental benefit? Nucl Med Commun 2013;34:203-210  https://doi.org/10.1097/MNM.0b013e32835c5a57
  53. Min JW, Lee SM, Chung DH, Yim JJ, Yang SC, Yoo CG, et al. Clinical significance of non-diagnostic pathology results from percutaneous transthoracic needle lung biopsy: experience of a tertiary hospital without an on-site cytopathologist. Respirology 2009;14:1042-1050  https://doi.org/10.1111/j.1440-1843.2009.01610.x
  54. Kim JI, Park CM, Kim H, Lee JH, Goo JM. Non-specific benign pathological results on transthoracic core-needle biopsy: how to differentiate false-negatives? Eur Radiol 2017;27:3888-3895  https://doi.org/10.1007/s00330-017-4766-3
  55. Lee KH, Lim KY, Suh YJ, Hur J, Han DH, Kang MJ, et al. Nondiagnostic percutaneous transthoracic needle biopsy of lung lesions: a multicenter study of malignancy risk. Radiology 2019;290:814-823  https://doi.org/10.1148/radiol.2018181482
  56. Callister ME, Baldwin DR, Akram AR, Barnard S, Cane P, Draffan J, et al. British Thoracic Society guidelines for the investigation and management of pulmonary nodules. Thorax 2015;70 Suppl 2:ii1-ii54  https://doi.org/10.1136/thoraxjnl-2015-207168
  57. Sconfienza LM, Mauri G, Grossi F, Truini M, Serafini G, Sardanelli F, et al. Pleural and peripheral lung lesions: comparison of US- and CT-guided biopsy. Radiology 2013;266:930-935  https://doi.org/10.1148/radiol.12112077
  58. Jeon KN, Bae K, Park MJ, Choi HC, Shin HS, Shin S, et al. US-guided transthoracic biopsy of peripheral lung lesions: pleural contact length influences diagnostic yield. Acta Radiol 2014;55:295-301  https://doi.org/10.1177/0284185113494984
  59. Lee MH, Lubner MG, Hinshaw JL, Pickhardt PJ. Ultrasound guidance versus CT guidance for peripheral lung biopsy: performance according to lesion size and pleural contact. AJR Am J Roentgenol 2018;210:W110-W117  https://doi.org/10.2214/AJR.17.18014
  60. Lee KH, Lim KY, Suh YJ, Hur J, Han DH, Kang MJ, et al. Diagnostic accuracy of percutaneous transthoracic needle lung biopsies: a multicenter study. Korean J Radiol 2019;20:1300-1310  https://doi.org/10.3348/kjr.2019.0189
  61. Balter S, Hopewell JW, Miller DL, Wagner LK, Zelefsky MJ. Fluoroscopically guided interventional procedures: a review of radiation effects on patients' skin and hair. Radiology 2010;254:326-341  https://doi.org/10.1148/radiol.2542082312
  62. Steele JR, Jones AK, Ninan EP. Quality initiatives: establishing an interventional radiology patient radiation safety program. Radiographics 2012;32:277-287  https://doi.org/10.1148/rg.321115002
  63. Lim C, Lee KY, Kim YK, Ko JM, Han DH. CT-guided core biopsy of malignant lung lesions: how many needle passes are needed? J Med Imaging Radiat Oncol 2013;57:652-656  https://doi.org/10.1111/1754-9485.12054
  64. Beck KS, Kim TJ, Lee KY, Kim YK, Kang JH, Han DH. CT-guided coaxial biopsy of malignant lung lesions: are cores from 20-gauge needle adequate for histologic diagnosis and molecular analysis? J Thorac Dis 2019;11:753-765  https://doi.org/10.21037/jtd.2019.02.48
  65. Yeow KM, Su IH, Pan KT, Tsay PK, Lui KW, Cheung YC, et al. Risk factors of pneumothorax and bleeding: multivariate analysis of 660 CT-guided coaxial cutting needle lung biopsies. Chest 2004;126:748-754  https://doi.org/10.1378/chest.126.3.748
  66. Lee SM, Park CM, Lee KH, Bahn YE, Kim JI, Goo JM. C-arm cone-beam CT-guided percutaneous transthoracic needle biopsy of lung nodules: clinical experience in 1108 patients. Radiology 2014;271:291-300  https://doi.org/10.1148/radiol.13131265
  67. Cox JE, Chiles C, McManus CM, Aquino SL, Choplin RH. Transthoracic needle aspiration biopsy: variables that affect risk of pneumothorax. Radiology 1999;212:165-168  https://doi.org/10.1148/radiology.212.1.r99jl33165
  68. Ko JP, Shepard JO, Drucker EA, Aquino SL, Sharma A, Sabloff B, et al. Factors influencing pneumothorax rate at lung biopsy: are dwell time and angle of pleural puncture contributing factors? Radiology 2001;218:491-496  https://doi.org/10.1148/radiology.218.2.r01fe33491
  69. Yeow KM, See LC, Lui KW, Lin MC, Tsao TC, Ng KF, et al. Risk factors for pneumothorax and bleeding after CT-guided percutaneous coaxial cutting needle biopsy of lung lesions. J Vasc Interv Radiol 2001;12:1305-1312  https://doi.org/10.1016/S1051-0443(07)61556-5
  70. Geraghty PR, Kee ST, McFarlane G, Razavi MK, Sze DY, Dake MD. CT-guided transthoracic needle aspiration biopsy of pulmonary nodules: needle size and pneumothorax rate. Radiology 2003;229:475-481  https://doi.org/10.1148/radiol.2291020499
  71. Hiraki T, Mimura H, Gobara H, Shibamoto K, Inoue D, Matsui Y, et al. Incidence of and risk factors for pneumothorax and chest tube placement after CT fluoroscopy-guided percutaneous lung biopsy: retrospective analysis of the procedures conducted over a 9-year period. AJR Am J Roentgenol 2010;194:809-814  https://doi.org/10.2214/AJR.09.3224
  72. Saji H, Nakamura H, Tsuchida T, Tsuboi M, Kawate N, Konaka C, et al. The incidence and the risk of pneumothorax and chest tube placement after percutaneous CT-guided lung biopsy: the angle of the needle trajectory is a novel predictor. Chest 2002;121:1521-1526  https://doi.org/10.1378/chest.121.5.1521
  73. Heerink WJ, de Bock GH, de Jonge GJ, Groen HJ, Vliegenthart R, Oudkerk M. Complication rates of CT-guided transthoracic lung biopsy: meta-analysis. Eur Radiol 2017;27:138-148  https://doi.org/10.1007/s00330-016-4357-8
  74. O'Neill AC, McCarthy C, Ridge CA, Mitchell P, Hanrahan E, Butler M, et al. Rapid needle-out patient-rollover time after percutaneous CT-guided transthoracic biopsy of lung nodules: effect on pneumothorax rate. Radiology 2012;262:314-319  https://doi.org/10.1148/radiol.11103506
  75. Huo YR, Chan MV, Habib AR, Lui I, Ridley L. Post-biopsy manoeuvres to reduce pneumothorax incidence in CT-guided transthoracic lung biopsies: a systematic review and meta-analysis. Cardiovasc Intervent Radiol 2019;42:1062-1072  https://doi.org/10.1007/s00270-019-02196-8
  76. Drumm O, Joyce EA, de Blacam C, Gleeson T, Kavanagh J, McCarthy E, et al. CT-guided lung biopsy: effect of biopsy-side down position on pneumothorax and chest tube placement. Radiology 2019;292:190-196  https://doi.org/10.1148/radiol.2019182321
  77. Perlmutt LM, Braun SD, Newman GE, Oke EJ, Dunnick NR. Timing of chest film follow-up after transthoracic needle aspiration. AJR Am J Roentgenol 1986;146:1049-1050  https://doi.org/10.2214/ajr.146.5.1049
  78. Choi CM, Um SW, Yoo CG, Kim YW, Han SK, Shim YS, et al. Incidence and risk factors of delayed pneumothorax after transthoracic needle biopsy of the lung. Chest 2004;126:1516-1521  https://doi.org/10.1378/chest.126.5.1516
  79. Lim WH, Park CM, Yoon SH, Lim HJ, Hwang EJ, Lee JH, et al. Time-dependent analysis of incidence, risk factors and clinical significance of pneumothorax after percutaneous lung biopsy. Eur Radiol 2018;28:1328-1337  https://doi.org/10.1007/s00330-017-5058-7
  80. Song YS, Park CM, Park KW, Kim KG, Lee HJ, Shim MS, et al. Does antiplatelet therapy increase the risk of hemoptysis during percutaneous transthoracic needle biopsy of a pulmonary lesion? AJR Am J Roentgenol 2013;200:1014-1019  https://doi.org/10.2214/AJR.12.8931
  81. Kim H, Park CM, Yoon SH, Hwang EJ, Lee JH, Ahn SY, et al. Open bronchus sign on CT: a risk factor for hemoptysis after percutaneous transthoracic biopsy. Korean J Radiol 2018;19:880-887  https://doi.org/10.3348/kjr.2018.19.5.880
  82. Lordan JL, Gascoigne A, Corris PA. The pulmonary physician in critical care.illustrative case 7: assessment and management of massive haemoptysis. Thorax 2003;58:814-819  https://doi.org/10.1136/thorax.58.9.814
  83. Davidson K, Shojaee S. Managing massive hemoptysis. Chest 2020;157:77-88  https://doi.org/10.1016/j.chest.2019.07.012
  84. Hakanson E, Konstantinov IE, Fransson SG, Svedjeholm R. Management of life-threatening haemoptysis. Br J Anaesth 2002;88:291-295  https://doi.org/10.1093/bja/88.2.291
  85. Kang MJ, Kim JH, Kim YK, Lee HJ, Shin KM, Kim JI, et al. 2018 Korean clinical imaging guideline for hemoptysis. Korean J Radiol 2018;19:866-871  https://doi.org/10.3348/kjr.2018.19.5.866
  86. Muth CM, Shank ES. Gas embolism. N Engl J Med 2000;342:476-482  https://doi.org/10.1056/NEJM200002173420706
  87. Ziser A, Adir Y, Lavon H, Shupak A. Hyperbaric oxygen therapy for massive arterial air embolism during cardiac operations. J Thorac Cardiovasc Surg 1999;117:818-821  https://doi.org/10.1016/S0022-5223(99)70304-1
  88. van Hulst RA, Klein J, Lachmann B. Gas embolism: pathophysiology and treatment. Clin Physiol Funct Imaging 2003;23:237-246  https://doi.org/10.1046/j.1475-097X.2003.00505.x
  89. Coulter TD, Wiedemann HP. Gas embolism. N Engl J Med 2000;342:2000-2002  https://doi.org/10.1056/NEJM200006293422617
  90. Alkadhi H, Wildermuth S, Desbiolles L, Schertler T, Crook D, Marincek B, et al. Vascular emergencies of the thorax after blunt and iatrogenic trauma: multi-detector row CT and three-dimensional imaging. Radiographics 2004;24:1239-1255  https://doi.org/10.1148/rg.245035728
  91. Whigham CJ Jr, Fisher RG, Goodman CJ, Dodds CA, Trinh CC. Traumatic injury of the internal mammary artery: embolization versus surgical and nonoperative management. Emerg Radiol 2002;9:201-207  https://doi.org/10.1007/s10140-002-0226-7
  92. Chemelli AP, Thauerer M, Wiedermann F, Strasak A, Klocker J, Chemelli-Steingruber IE. Transcatheter arterial embolization for the management of iatrogenic and blunt traumatic intercostal artery injuries. J Vasc Surg 2009;49:1505-1513  https://doi.org/10.1016/j.jvs.2009.02.001
  93. Kurban LA, Gomersall L, Weir J, Wade P. Fluoroscopy-guided percutaneous lung biopsy: a valuable alternative to computed tomography. Acta Radiol 2008;49:876-882  https://doi.org/10.1080/02841850802225893
  94. Lee HN, Lee SM, Choe J, Lee SM, Chae EJ, Do KH, et al. Diagnostic performance of CT-guided percutaneous transthoracic core needle biopsy using low tube voltage (100 kVp): comparison with conventional tube voltage (120 kVp). Acta Radiol 2018;59:425-433  https://doi.org/10.1177/0284185117719589
  95. Kim GR, Hur J, Lee SM, Lee HJ, Hong YJ, Nam JE, et al. CT fluoroscopy-guided lung biopsy versus conventional CT-guided lung biopsy: a prospective controlled study to assess radiation doses and diagnostic performance. Eur Radiol 2011;21:232-239  https://doi.org/10.1007/s00330-010-1936-y
  96. Winn N, Spratt J, Wright E, Cox J. Patient reported experiences of CT guided lung biopsy: a prospective cohort study. Multidiscip Respir Med 2014;9:53 
  97. Matsuguma H, Nakahara R, Kondo T, Kamiyama Y, Mori K, Yokoi K. Risk of pleural recurrence after needle biopsy in patients with resected early stage lung cancer. Ann Thorac Surg 2005;80:2026-2031  https://doi.org/10.1016/j.athoracsur.2005.06.074
  98. Ahn SY, Yoon SH, Yang BR, Kim YT, Park CM, Goo JM. Risk of pleural recurrence after percutaneous transthoracic needle biopsy in stage I non-small-cell lung cancer. Eur Radiol 2019;29:270-278 https://doi.org/10.1007/s00330-018-5561-5