Validation of Risk Prediction Models for Pneumothorax and Intercostal Catheter Insertion Following CT-Guided Lung Biopsy.

Abstract

Background: CT-guided percutaneous transthoracic needle biopsy is the primary method for diagnosing lung lesions. Widely accepted validated risk prediction models are yet to be developed. A recently published study conducted at Grampians Health Services (GHS) developed two risk prediction models for predicting pneumothorax and intercostal catheter (ICC) insertion. This study aims to validate these models.

Methods: This is a single-centre, retrospective cohort study performed at GHS. Patients with a CT-guided lung biopsy between January 2020 and July 2023 were included, alongside target-lesion characteristics, procedural-related factors and complications. Predicted probabilities for pneumothorax and ICC insertion were generated for each patient, and the diagnostic accuracy of the previous risk prediction models was evaluated the area under the receiver operating characteristic. A Youden Index was used to determine the sensitivity and specificity at the optimal probability thresholds.

Results: The validation found the model published by GHS demonstrated a diagnostic accuracy of 0.695 (95% CI: 0.601-0.695) for predicting pneumothorax following CT-guided percutaneous biopsy. The model for predicting intercostal catheter insertion had a diagnostic accuracy of 0.762 (95% CI: 0.642-0.762). The sensitivity for predicting pneumothorax and ICC insertion was 81.97% and 92.86%, respectively, for their optimum probability thresholds.

Conclusion: The findings suggest that the previously published models may be useful in predicting pneumothoraces and ICC insertion following CT-guided percutaneous biopsy. We recommend these models as an adjunctive tool to aid in clinical decision-making during the peri-procedural management of these patients pending further validation with an external cohort.