Abstract No. 348 Rapid Rollover Technique on Pneumothorax After Percutaneous CT-Guided Lung Biopsy: A Randomized Controlled Trial

To investigate the effect of the rapid rollover technique on the risk of pneumothorax after CT-guided lung biopsy, which has been shown effective in prior retrospective studies. A prospective, multisite, randomized controlled trial (RCT) has been in progress since institutional review board approval (NCT05342675). All patients referred for CT-guided lung biopsy were reviewed. Those with target lesions most amenable to anterior or lateral approach were considered for inclusion, as posterior approach patients naturally roll over after biopsies. Exclusion criteria include subpleural nodules, intra-procedural chest tube placement, or pre-existing conditions intolerant to prone or lateral decubitus positions. Intervention arm patients who recovered in the recommended position for > 30 minutes were considered complete. The primary outcome was new or enlarging pneumothorax on post-biopsy chest radiographs, and secondary outcome was chest tube insertion rate. The two groups were compared with independent t-tests for continuous variable and χ2 tests for categorical variables. A p-value < 0.05 was considered significant. Of the 342 patients screened, 71 patients met inclusion criteria, 45 patients enrolled so far, and 40 patients included in the outcome analysis due to lack of post-biopsy radiographs in 5 patients. Nineteen were randomized to intervention and 21 to control. The median age was 68.5 (interquartile range or IQR: 61.5-75) and 65 (IQR: 56.3–77.3) in intervention and control groups (p = 0.71). There were no significant differences in gender, smoking history, indication, morphology, history of radiation, or number of passes through the pleura or fissure. The median nodule/mass size was 18 mm (IQR: 10 - 33) and 13.5 mm (IQR 10–29.3) in intervention and control groups (p = 0.51). The median needle-path length and needle-pleura angle was 30 mm (IQR: 20 - 39) and 66 degrees (IQR: 47–80) in the intervention arm, 26 mm (IQR 14 - 44) and 54 degrees (IQR: 40–81.8) in the control arm (p values of 0.93 and 0.58). The intention-to-treat (ITT) analysis showed significantly higher risk of new or enlarging pneumothorax (1/19 and 7/21 patients in intervention and control arms, p = 0.027). The 1 patient who developed pneumothorax in the intervention group was not able to complete the intervention. Only 2 patients required chest tubes, both from the control group (p = 0.17 and 0.20 by ITT and PP). This multisite RCT found that rapid rollover reduces the risk of new or enlarging pneumothorax after CT-guided lung biopsy.