Procedural Optimization in CT-Guided Lung Biopsy: Impact of Needle Angle and Patient Positioning on Complication Rates

Background/Objectives: CT-guided lung biopsy is an essential diagnostic procedure but is associated with complications such as pneumothorax and pulmonary hemorrhage. While patient- and lesion-related factors are well established, operator-modifiable parameters remain less clearly defined. This study aimed to evaluate complication rates and identify independent predictors, with a particular focus on modifiable procedural factors. Methods: This retrospective study included 309 consecutive patients undergoing CT-guided transthoracic lung biopsy. Patient, lesion, and procedural variables—including needle–pleura angle and patient positioning—were analyzed. Complications were classified according to the Society of Interventional Radiology (SIR) system. Multivariate logistic regression analyses were performed to identify independent predictors. Results: Complications occurred in 20.4% of patients, with pneumothorax (14.2%) and hemorrhage (4.9%) being the most frequent. A needle angle ≤ 65° was independently associated with major complications (OR = 8.12, p = 0.025). Perilesional emphysema (OR = 19.38, p = 0.004) and pleural effusion (OR = 30.72, p = 0.001) were also strong predictors. Supine positioning significantly increased hemorrhage risk (OR = 9.03, p = 0.043). Conclusions: Operator-modifiable factors, particularly needle angle and patient positioning, may influence complication risk. Optimization of these parameters may provide a practical approach to improving procedural safety in CT-guided lung biopsy.