Efficacy of needle tract embolization using gelfoam in reducing incidence of pneumothorax in CT-guided transthoracic lung biopsies: a systematic review and meta-analysis

Abstract

Objective: Transthoracic CT-guided lung biopsy is associated with risk of pneumothorax, requiring chest tube placement at times. From available literature, we tried to compare the incidence rate of pneumothorax in cases undergoing CT-guided lung biopsy with versus without use of gelfoam slurry for tract occlusion.

Methods: Databases like SCOPUS, PubMed, Google Scholar, and EMBASE were searched for original studies analysing the efficacy of gelfoam for needle tract embolization following CT-guided lung biopsy till September 2023. Bias in the selected studies was assessed using the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool. Pooled odds ratio of the effect of gelfoam slurry on the rate of pneumothorax and chest tube placement following CT-guided lung biopsy was calculated and represented with 95% confidence intervals (95% CI) and prediction interval (PI).

Results: Pooled analysis of six studies revealed that patients undergoing needle tract embolization when compared to non-embolized patients had a significantly decreased risk of pneumothorax with odds reduced by 59% (OR = 0.41, 95% CI = 0.25-0.66, P = .01; PI = -1.694 to 0.094). Also, it led to a significant reduction in severe pneumothorax requiring chest tube placement with reduced odds by 63% (OR = 0.37, 95% CI = 0.20-0.69, P = .01; PI = -1.855 to 0.115).

Conclusion: Needle tract embolization using gelfoam has a significant protective effect against pneumothorax as well as chest tube insertion in patients undergoing CT-guided lung biopsy.

Advances in knowledge: Gelfoam needle tract embolization can effectively reduce the risk of pneumothorax and chest tube requirement after lung biopsy.

Prospero registration id: CRD42024505788.

Keywords: CT-guided lung biopsy; gelfoam slurry; pneumothorax; tract embolization.