Incidence and Risk Factors of Pulmonary Hemorrhage After Percutaneous CT-Guided Pulmonary Nodule Biopsy: An Observational Study

Objectives: To evaluate the current incidence of pulmonary hemorrhage and the potential factors contributing to its increased risk after percutaneous CT-Guided pulmonary nodule biopsy and to recapitulate the technical recommendations for its treatment. Materials: and Methods: In this observational study, patient data were collected from ten medical centers from April 2021 to April 2022. Pulmonary hemorrhage was graded as follows: 0, none; 1, less than or equal to 2 cm around the needle or lesion; 2, more than 2 cm and less than 4 cm; 3, more than4 cm; and 4, hemoptysis or bleeding into the other lobes. High-grade pulmonary hemorrhage was defined as grade 2 or higher pulmonary hemorrhage. Results: The incidence of pulmonary hemorrhage was as follows: grade 0, 36.1% (214/593); grade 1, 36.8% (218/593);grade 2, 18.9% (112/593); grade 3,3.5% (21/593); andgrade 4, 4.7% (28/593). High-grade hemorrhage (HGH) occurred in 27.2% (161/593) of the patients. The use of preoperativebreathing exercises (PBE, P=0.000), semiautomatic cutting needles (SCN, p=0.004), immediatecontrastenhancement (ICE, P=0.021), and the coaxial technique (CoT, p=0.000) were protective factors for HGH. Greater length of puncture (P=0.021), the presence of hilar nodules (p=0.001), the presence of intermediate nodules (p=0.026), main pulmonary artery diameter (mPAD) larger than 29 mm (p=0.015), and small nodule size (p=0.014) were risk factors for high-grade hemorrhage. The area under the curve (AUC) was 0.783. Conclusions: : The PSIC approach, which includes PBE, SCN, ICE, and CoT, has been found to be a protective factor for HGH in real-world scenarios. Furthermore, this protocol is beneficial for creating specialized puncture instruments for percutaneous CT-Guided pulmonary nodule biopsy.