Renda Soylemez Wiener, MD, MPH; H. Gilbert Welch, MD, MPH
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M10-2560.
Wiener R., Welch H.; Risk for Complications After Transthoracic Needle Lung Biopsy. Ann Intern Med. 2011;155:796. doi: 10.7326/0003-4819-155-11-201112060-00024
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Published: Ann Intern Med. 2011;155(11):796.
We appreciate Dr. Leong's interest in our study. We recognize that newer bronchoscopic techniques guided by endobronchial ultrasonography or electromagnetic navigation may be considered, if available, when the clinician is deciding how to evaluate a patient with a pulmonary nodule. However, we were unable to include these procedures in our analysis because they do not have dedicated International Statistical Classification of Diseases and Related Health Problems, Volume 9, procedure codes assigned to them. We therefore cannot comment on use or complication rates of these procedures.
We fully agree with Dr. Leong that individual characteristics must be considered when estimating the risk for complications of transthoracic needle biopsy. Unfortunately, the administrative databases we used for this analysis lacked clinical detail and we could not assess the effects of important individual characteristics, such as nodule size and location on risk for complications. Our goal in this study was to provide an estimate of the risk for complications after transthoracic needle biopsy (CT-guided biopsy) when all patients having the procedure were considered; for individuals, the pretest probability of a complication may of course be higher or lower based on personal risk factors.
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