Advancing Evidence on Saline Tract Sealing for Pneumothorax Prevention in CT-Guided Lung Biopsy: A Randomized Controlled Trial

The aim of the study is to evaluate effectiveness of normal saline tract sealing in reducing pneumothorax incidence during CT-guided lung biopsy compared with no specific intervention. A prospective, randomized controlled study was conducted with 148 patients undergoing CT-guided lung biopsy, randomized into two groups: saline sealing (Group A, n = 75) and no sealing (Group B, n = 73). All procedures were performed by an experienced radiologist using standardized protocol. Normal saline (4 mL) was instilled into needle tract during withdrawal in Group A, while Group B underwent standard needle withdrawal without any intervention. The primary outcome was incidence of pneumothorax, assessed on post-procedure CT. Risk factors for pneumothorax were analyzed using univariate and multivariate logistic regression. Incidence of pneumothorax was lower in saline group (12.0%) compared with the no-saline group (24.7%), but this difference did not reach statistical significance (p = 0.075). No patients in either group required chest tube drainage. Multivariate analysis identified saline sealing as significant protective factor (OR = 0.298, 95% CI: 0.104–0.853, p = 0.024). Procedural factors, including lateral needle puncture (OR = 8.664, 95% CI: 1.469–51.098, p = 0.017) and four pleural punctures (OR = 10.785, 95% CI: 1.119–103.951, p = 0.040), were associated with increased pneumothorax risk. Normal saline tract sealing effectively reduces pneumothorax risk in CT-guided lung biopsy and is simple and cost-effective. These findings support its broader adoption, with further multicenter studies recommended to validate results and optimize technique.