What are the complications of percutaneous biopsy?
Percutaneous needle biopsies are safe procedures, and the risk of serious complications is low. Complications can be stratified as minor and major complications. Major complications result in hospital admission for therapy, an unplanned increase in the level of care, prolonged hospitalization, permanent adverse sequelae, or death. Minor complications result in no sequelae, require little or no therapy, or require a short hospital stay for observation. Major complications of percutaneous biopsy include bleeding that requires transfusion or intervention, infection, or organ or nerve injury. Major bleeding is infrequent and may be affected by needle size, use of cutting needles (core biopsy), and lesion vascularity. A very rare major complication includes seeding of the needle tract with tumor (<0.5% in all organs).
Following renal biopsy, bleeding can result in hematuria or a perinephric (retroperitoneal) or intrarenal hematoma. Hemorrhage requiring transfusion occurs in less than 0.5% to 6% of patients, depending on needle size, and renal loss is seen in less than 0.1% of cases. Renal arteriovenous fistula (AVF) formation, renal arterial pseudoaneurysm formation, infection, and adjacent organ injury can occur but are all rarely reported complications. The risk of tumor seeding after biopsy of a renal cancer is extremely low, with only a few reported cases in the literature.
Major bleeding in liver biopsies ranges from 0.3% to 3% and may result in subcapsular hematoma, hemoperitoneum, or hemobilia. Infection as the result of liver biopsy is rare. Damage to the target organ or nearby organ, such as with development of a pneumothorax, hepatic arterial pseudoaneurysm, or AVF, is also a rare complication.
Pneumothorax is the most common complication of lung biopsy, occurring in approximately one fourth of lung biopsies. Thoracostomy tube placement is necessary in 2% to 15% of patients with biopsy-related pneumothoraces. A pneumothorax occurring with a lung or mediastinal biopsy is considered as a minor complication when it does not require intervention or when thoracostomy tube placement results in a brief hospitalization (<48 hours). A pneumothorax following lung or mediastinal biopsy is considered as a major complication (in 1% to 2% of biopsies) when it results in prolonged hospitalization (>48 hours), placement of multiple thoracostomy tubes, or pleurodesis. Minor hemoptysis may occur after lung biopsy, but hemoptysis requiring hospitalization or intervention is a rare complication (in 0.5% of biopsies). The most serious and very rare complication of lung biopsy is air embolism, where air enters the heart or vessels, which is reported in 0.06% to 0.07% of cases.