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Impacto do FEV1 no risco de pneumotórax pós-biópsia transtorácica
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Introdução: A biópsia transtorácica com agulha (TTNB) do pulmão é um procedimento realizado no estudo de lesões pulmonares com o intuito de obter um diagnóstico histológico, apresentando como complicação mais frequente o pneumotórax (4,3-52,4%). A ocorrência deste associa-se a vários fatores de risco, não sendo consensual a sua relação com a doença pulmonar obstrutiva crónica (DPOC) nem com o grau de obstrução pulmonar, avaliado pelo volume expiratório forçado no 1º segundo (FEV1). Objetivo: Este trabalho pretende avaliar o papel do FEV1, no risco de pneumotórax pós-TTNB (objetivo primário), assim como avaliar outros fatores de risco (objetivo secundário). Materiais e métodos: TTNBs realizadas entre Janeiro de 2021 e Março de 2023 foram retrospetivamente analisadas para selecionar o coorte de estudo. Caraterísticas sociodemográficas, dados da função pulmonar e variáveis relacionadas com as lesões e o procedimento, foram submetidas a análise estatística univariada e multivariada, através do software SPSS. Valores de p-value < 0,05 foram considerados significativos. Resultados: 88 de 298 pacientes foram incluídos no estudo. O diâmetro médio das lesões (p-value=0,003, OR -0,1), as bolhas no trajeto (p-value<0,001, OR 22,5), as bronquiectasias (pvalue= 0,011, OR 1,7) e o tabagismo ativo (p-value=0,007, OR 2,4), apresentaram significância em análise univariada e multivariada. A presença de enfisema (p-value=0,036) e a capacidade de difusão do monóxido de carbono não corrigida para o volume alveolar (DLCO) (p-value=0,035) ou corrigida (DLCO/VA) (p-value=0,001) foram significativos em análise univariada. O FEV1 não se associou à ocorrência de pneumotórax. Conclusão: O diâmetro da lesão e as alterações anatómicas do parênquima pulmonar parecem ser fatores de risco mais relevantes que as alterações da função pulmonar. A DLCO e DLCO/VA podem ser enquadradas enquanto preditores do risco de pneumotórax/enfisema e o tabagismo atual é fator de risco independente e o único passível de modificação pelo doente.
Introduction: Transthoracic needle biopsy (TTNB) of the lung is a procedure performed in the study of lung lesions to obtain a histological diagnosis, with pneumothorax as the most common complication (4.3-52.4%). Its occurrence is associated with several risk factors, but there is no consensus on its relationship with chronic obstructive pulmonary disease (COPD) or with the degree of pulmonary obstruction, as assessed by forced expiratory volume in one second (FEV1). Objective: This study aims to evaluate the role of FEV1 in the risk of pneumothorax after TTNB (primary objective), as well as to evaluate other risk factors (secondary objective). Materials and methods: TTNBs performed between January 2021 and March 2023 were retrospectively analyzed to select the study cohort. Sociodemographic characteristics, lung function data, and variables related to the lesions and procedure were subjected to univariate and multivariate statistical analysis using SPSS software. P values < 0.05 were considered significant. Results: 88 of 298 patients were included in the study. Mean lesion diameter (p-value=0.003, OR -0.1), tract blebs (p-value<0.001, OR 22.5), bronchiectasis (p-value=0.011, OR 1.7) and active smoking (p-value=0.007, OR 2.4), showed significance in univariate and multivariate analysis. The presence of emphysema (p-value=0.036) and carbon monoxide diffusing capacity not corrected for alveolar volume (DLCO) (p-value=0.035) or corrected (DLCO/VA) (p-value=0.001) were significant in univariate analysis. FEV1 was not associated with the occurrence of pneumothorax. Conclusion: Lesion diameter and anatomical changes of the lung parenchyma seem to be more relevant risk factors than pulmonary function changes. DLCO and DLCO/VA can be considered predictors of the risk of pneumothorax/emphysema and current smoking is an independent risk factor and the only one that can be modified by the patient.
Introduction: Transthoracic needle biopsy (TTNB) of the lung is a procedure performed in the study of lung lesions to obtain a histological diagnosis, with pneumothorax as the most common complication (4.3-52.4%). Its occurrence is associated with several risk factors, but there is no consensus on its relationship with chronic obstructive pulmonary disease (COPD) or with the degree of pulmonary obstruction, as assessed by forced expiratory volume in one second (FEV1). Objective: This study aims to evaluate the role of FEV1 in the risk of pneumothorax after TTNB (primary objective), as well as to evaluate other risk factors (secondary objective). Materials and methods: TTNBs performed between January 2021 and March 2023 were retrospectively analyzed to select the study cohort. Sociodemographic characteristics, lung function data, and variables related to the lesions and procedure were subjected to univariate and multivariate statistical analysis using SPSS software. P values < 0.05 were considered significant. Results: 88 of 298 patients were included in the study. Mean lesion diameter (p-value=0.003, OR -0.1), tract blebs (p-value<0.001, OR 22.5), bronchiectasis (p-value=0.011, OR 1.7) and active smoking (p-value=0.007, OR 2.4), showed significance in univariate and multivariate analysis. The presence of emphysema (p-value=0.036) and carbon monoxide diffusing capacity not corrected for alveolar volume (DLCO) (p-value=0.035) or corrected (DLCO/VA) (p-value=0.001) were significant in univariate analysis. FEV1 was not associated with the occurrence of pneumothorax. Conclusion: Lesion diameter and anatomical changes of the lung parenchyma seem to be more relevant risk factors than pulmonary function changes. DLCO and DLCO/VA can be considered predictors of the risk of pneumothorax/emphysema and current smoking is an independent risk factor and the only one that can be modified by the patient.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2023
Palavras-chave
Biópsia transtorácica com agulha do pulmão (TTNB) Pneumotórax Volume expiratório forçado no primeiro segundo (FEV1) Doença pulmonar obstrutiva crónica (DPOC) Pneumologia