Relationship between different techniques and complications in CT-guided transthoracic lung biopsies: a single-centre comprehensive analysis CT-guided lung biopsy: techniques and associated complications

Purpose To evaluate the relationship between different techniques, lesion characteristics, and the development of pneumothorax (Ptx), chest tube-requiring Ptx, and type 1 parenchymal contusion (T1PC) in computed tomographyguided transthoracic lung biopsies (CTTB). Material and methods This retrospective study included 510 patients who underwent CTTB between 2015 and 2020. Patients were classified according to needle system (coaxial (Cx)/non-coaxial (NCx)), needle gauge, use of autologous blood clot (OBC), lesion size, location, approach path, pleural puncture count, number of specimens, and presence of emphysema along the needle tract. Complications were assessed with post-procedural CT. Univariate and multivariate logistic regression analyses were performed. Results Ptx was more frequent in males, in the presence of emphysema along the needle tract, with middle lobe lesions, lateral approach, ≥ 3 pleural passes, ≥ 3 samples, and when using 18G NCx or 19G Cx needles. OBC use reduced Ptx risk. Chest tube-requiring Ptx was significantly associated with ≥ 3 pleural passes, ≥ 3 samples, and 19G Cx needles. T1PC was most common with 17G Cx needle use and when ≥ 3 samples were obtained. Multivariate analysis showed that 18G NCx and 19G Cx needles reduced T1PC risk, while the absence of Ptx increased its likelihood. Conclusions In CT-guided lung biopsies, complication risk can be reduced by optimizing technique, limiting pleural punctures and specimen numbers, and considering OBC use, needle gauge, and patient-specific factors.