Complications of synchronous microwave ablation and biopsy versus microwave ablation alone for pulmonary sub-solid nodules: a retrospective, large sample, case-control study.

Background: This was a retrospective, large-sample, case-control study assessing the complications associated with synchronous microwave ablation (MWA) and biopsy for pulmonary sub-solid nodules or ground-glass nodules (GGNs) versus MWA alone. We aimed to verify the safety of synchronous MWA and biopsy for treating GGNs.

Methods: From May 2020 to December 2021, 326 patients with GGNs were enrolled. Among them, 164 patients underwent MWA alone (group A) and 162 patients underwent synchronous MWA and biopsy (group B). We assessed the complications, technical success, and positivity rate of the biopsy.

Results: The major complications were similar between the two groups, and included pneumothorax (group A vs. group B, 19.5% vs. 13.6%; P=0.150), hemothorax (0.6% vs. 1.2%; P=1.000), pleural effusion (1.2% vs. 0.6%; P=1.000), and pulmonary infection (4.9% vs. 6.2%; P=0.609). No massive hemoptysis, bronchopleural fistula, or air embolism developed. Minor complications including intrapulmonary hemorrhage (group A vs. group B, 28.7% vs. 62.3%, P<0.001), mild pneumothorax (20.7% vs. 29.6%, P=0.587), mild ipsilateral pleural effusion (30.5% vs. 27.8%, P=0.590), mild bilateral pleural effusion (16.5% vs. 22.2%, P=0.188), and subcutaneous emphysema (4.3% vs. 5.6%, P=0.498) were observed. The side effects, including pain, cough, post-ablation syndrome, and post-ablation chronic pain syndrome, were similar between the two groups. The positive diagnosis rate of biopsy in group B was 88.3%.

Conclusions: Compared with MWA alone, synchronous MWA and biopsy did not increase the risk of major complications. Although some minor complications developed, synchronous MWA and biopsy is safe for treating pulmonary GGNs.