Development and validation of a risk nomogram predicting pneumothorax requiring chest tube placement post-percutaneous CT-guided lung biopsy
Abstract Background Pneumothorax requiring chest tube after CT-guided transthoracic lung biopsy presents added clinical risk and costs to the healthcare system. Identifying high-risk patients can prompt alternative biopsy modes and/or better preparation for more focused post-procedural care. We aime...
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BMC
2025-07-01
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| Series: | BMC Medical Imaging |
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| Online Access: | https://doi.org/10.1186/s12880-025-01794-y |
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| author | Masha Bondarenko Jianxiang Zhang Ulysis Hugo Baal Brian Lam Gunvant Chaudhari Yoo Jin Lee Jamie Schroeder Maya Vella Brian Haas Thienkhai Vu Kimberly Kallianos Jonathan Liu Shravan Sridhar Brett Elicker Jae Ho Sohn |
| author_facet | Masha Bondarenko Jianxiang Zhang Ulysis Hugo Baal Brian Lam Gunvant Chaudhari Yoo Jin Lee Jamie Schroeder Maya Vella Brian Haas Thienkhai Vu Kimberly Kallianos Jonathan Liu Shravan Sridhar Brett Elicker Jae Ho Sohn |
| author_sort | Masha Bondarenko |
| collection | DOAJ |
| description | Abstract Background Pneumothorax requiring chest tube after CT-guided transthoracic lung biopsy presents added clinical risk and costs to the healthcare system. Identifying high-risk patients can prompt alternative biopsy modes and/or better preparation for more focused post-procedural care. We aimed to develop and externally validate a risk nomogram for pneumothorax requiring chest tube placement following CT-guided lung biopsy, leveraging quantitative emphysema algorithm. Methods This two-center retrospective study included patients who underwent CT-guided lung biopsy from between 1994 and 2023. Data from one hospital was set aside for validation (n = 613). Emphysema severity was quantified and categorized to 3-point scale using a previously published algorithm based on 3×3×3 kernels and Hounsfield thresholding, and a risk calculator was developed using forward variable selection and logistic regression. The model was validated using bootstrapping and Harrell’s C-index. Results 2,512 patients (mean age, 64.47 years ± 13.38 [standard deviation]; 1250 men) were evaluated, of whom 157 (6.7%) experienced pneumothorax complications requiring chest tube placement. After forward variable selection to reduce the covariates to maximize clinical usability, the risk score was developed using age over 60 (OR 1.80 [1.15–2.93]), non-prone patient position (OR 2.48 [1.63–3.75]), and severe emphysema (OR 1.99 [1.35–2.94]). The nomogram showed a mean absolute error of 0.5% in calibration and Harrell’s C-index of 0.664 in discrimination in the internal cohort. Conclusion The developed nomogram predicts age over 60, non-prone position during biopsy, and severe emphysema to be most predictive of pneumothorax requiring chest tube placement following CT-guided lung biopsy. |
| format | Article |
| id | doaj-art-e3c2a8572bd44e33ad9159fc6a0d1201 |
| institution | DOAJ |
| issn | 1471-2342 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | BMC |
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| series | BMC Medical Imaging |
| spelling | doaj-art-e3c2a8572bd44e33ad9159fc6a0d12012025-08-20T03:04:07ZengBMCBMC Medical Imaging1471-23422025-07-012511910.1186/s12880-025-01794-yDevelopment and validation of a risk nomogram predicting pneumothorax requiring chest tube placement post-percutaneous CT-guided lung biopsyMasha Bondarenko0Jianxiang Zhang1Ulysis Hugo Baal2Brian Lam3Gunvant Chaudhari4Yoo Jin Lee5Jamie Schroeder6Maya Vella7Brian Haas8Thienkhai Vu9Kimberly Kallianos10Jonathan Liu11Shravan Sridhar12Brett Elicker13Jae Ho Sohn14Department of Radiology and Biomedical Imaging, University of California San Francisco (UCSF)University of California Berkeley (UCB)Department of Radiology and Biomedical Imaging, University of California San Francisco (UCSF)Department of Radiology and Biomedical Imaging, University of California San Francisco (UCSF)Department of Radiology and Biomedical Imaging, University of California San Francisco (UCSF)Department of Radiology and Biomedical Imaging, University of California San Francisco (UCSF)Department of Radiology and Biomedical Imaging, University of California San Francisco (UCSF)Department of Radiology and Biomedical Imaging, University of California San Francisco (UCSF)Department of Radiology and Biomedical Imaging, University of California San Francisco (UCSF)Department of Radiology and Biomedical Imaging, University of California San Francisco (UCSF)Department of Radiology and Biomedical Imaging, University of California San Francisco (UCSF)Department of Radiology and Biomedical Imaging, University of California San Francisco (UCSF)Department of Radiology and Biomedical Imaging, University of California San Francisco (UCSF)Department of Radiology and Biomedical Imaging, University of California San Francisco (UCSF)Department of Radiology and Biomedical Imaging, University of California San Francisco (UCSF)Abstract Background Pneumothorax requiring chest tube after CT-guided transthoracic lung biopsy presents added clinical risk and costs to the healthcare system. Identifying high-risk patients can prompt alternative biopsy modes and/or better preparation for more focused post-procedural care. We aimed to develop and externally validate a risk nomogram for pneumothorax requiring chest tube placement following CT-guided lung biopsy, leveraging quantitative emphysema algorithm. Methods This two-center retrospective study included patients who underwent CT-guided lung biopsy from between 1994 and 2023. Data from one hospital was set aside for validation (n = 613). Emphysema severity was quantified and categorized to 3-point scale using a previously published algorithm based on 3×3×3 kernels and Hounsfield thresholding, and a risk calculator was developed using forward variable selection and logistic regression. The model was validated using bootstrapping and Harrell’s C-index. Results 2,512 patients (mean age, 64.47 years ± 13.38 [standard deviation]; 1250 men) were evaluated, of whom 157 (6.7%) experienced pneumothorax complications requiring chest tube placement. After forward variable selection to reduce the covariates to maximize clinical usability, the risk score was developed using age over 60 (OR 1.80 [1.15–2.93]), non-prone patient position (OR 2.48 [1.63–3.75]), and severe emphysema (OR 1.99 [1.35–2.94]). The nomogram showed a mean absolute error of 0.5% in calibration and Harrell’s C-index of 0.664 in discrimination in the internal cohort. Conclusion The developed nomogram predicts age over 60, non-prone position during biopsy, and severe emphysema to be most predictive of pneumothorax requiring chest tube placement following CT-guided lung biopsy.https://doi.org/10.1186/s12880-025-01794-yPneumothoraxImage-guided biopsyLung neoplasms |
| spellingShingle | Masha Bondarenko Jianxiang Zhang Ulysis Hugo Baal Brian Lam Gunvant Chaudhari Yoo Jin Lee Jamie Schroeder Maya Vella Brian Haas Thienkhai Vu Kimberly Kallianos Jonathan Liu Shravan Sridhar Brett Elicker Jae Ho Sohn Development and validation of a risk nomogram predicting pneumothorax requiring chest tube placement post-percutaneous CT-guided lung biopsy BMC Medical Imaging Pneumothorax Image-guided biopsy Lung neoplasms |
| title | Development and validation of a risk nomogram predicting pneumothorax requiring chest tube placement post-percutaneous CT-guided lung biopsy |
| title_full | Development and validation of a risk nomogram predicting pneumothorax requiring chest tube placement post-percutaneous CT-guided lung biopsy |
| title_fullStr | Development and validation of a risk nomogram predicting pneumothorax requiring chest tube placement post-percutaneous CT-guided lung biopsy |
| title_full_unstemmed | Development and validation of a risk nomogram predicting pneumothorax requiring chest tube placement post-percutaneous CT-guided lung biopsy |
| title_short | Development and validation of a risk nomogram predicting pneumothorax requiring chest tube placement post-percutaneous CT-guided lung biopsy |
| title_sort | development and validation of a risk nomogram predicting pneumothorax requiring chest tube placement post percutaneous ct guided lung biopsy |
| topic | Pneumothorax Image-guided biopsy Lung neoplasms |
| url | https://doi.org/10.1186/s12880-025-01794-y |
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