CT-Guided Core and Fine Needle Aspiration Transthoracic Lung Biopsies: Multivariate Analysis of Risk Factors Associated with Pneumothorax and Effect of Dwell Time in Core Biopsies

Purpose: To compare CT-guided core and fine-needle aspiration TTLBs in terms of complication rates, diagnostic adequacy, and dwell time and to investigate the independent risk factors associated with pneumothorax. Material and Methods: 247 consecutive biopsies (125 core and 122 FNA) were evaluated retrospectively. 17-18 G co-axial system was used in the core, and 19-22 G co-axial system was used in FNA biopsies. Lesions less than 10 mm were excluded since all were performed with FNA. The dwell time of each biopsy was noted. Results: The median age of the study group was 63 (183 males, 64 females). There was no significant difference between the core and FNA biopsy groups regarding age, gender, other parenchymal diseases, lesion localization, and traversed lung. Median dwell time was significantly shorter in the core biopsy. PX rate was 19.4%. Nineteen patients (7.7%) had PX requiring treatment. PX was not found to be related to the biopsy needle (core or FNA), even though its rate was significantly higher in the FNA. 5.5 minutes was the threshold dwell time for the occurrence of PX in the core biopsies. Dwell time more than this increased the risk by 4.9 times. Conclusion: Diagnostic adequacy and major complication rates of core biopsies are similar to FNAB. Although PX rates were higher in FNA biopsies, the biopsy type did not affect the risk. The threshold time for the safe procedure in core biopsies has been 5.5 minutes.