Saline tract sealing to reduce pneumothorax rates following CT-guided percutaneous lung biopsy: a systematic review and meta-analysis

Objectives Pneumothorax remains the most common complication following CT-guided percutaneous lung biopsy, increasing morbidity and healthcare utilisation. Saline tract sealing has been proposed as a simple technique to reduce the risk of pneumothorax, but its effectiveness remains unclear. Materials and methods A systematic review and meta-analysis were performed according to PRISMA guidelines. PubMed, Embase, and CENTRAL were searched for studies evaluating saline tract sealing following CT-guided percutaneous lung biopsy. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects model for pneumothorax and chest drain insertion. Results The search identified 151 articles, of which 11 studies met the inclusion criteria. Ten studies (one randomised controlled trial and nine observational studies) comprising 2252 patients compared saline tract sealing with no sealant and were included in the meta-analysis. One study used an alternative sealant comparator and was synthesised narratively. Saline tract sealing was associated with a significant reduction in pneumothorax (RR 0.58, 95% CI: 0.42–0.80; I ² = 82%) and chest drain insertion (RR 0.30, 95% CI: 0.15–0.61; I ² = 55%). These findings remained robust on sensitivity analysis excluding studies incorporating rapid patient rollover as a co-intervention, with persistent reductions in pneumothorax (RR 0.51, 95% CI: 0.33–0.78) and chest drain insertion (RR 0.31, 95% CI: 0.13–0.75). Conclusion Saline tract sealing may be an effective and practical strategy to reduce the incidence of pneumothorax and chest drain insertion after CT-guided percutaneous lung biopsy. Given the very low certainty of the current evidence, further randomised controlled trials are required to confirm these findings. Key Points Question Does saline tract sealing reduce rates of pneumothorax and chest drain insertion following CT-guided percutaneous lung biopsy? Findings Saline tract sealant was associated with reduced rates of pneumothorax and chest drain insertion following CT-guided percutaneous lung biopsy compared with no sealant . Clinical relevance Saline tract sealing is a simple, low-cost technique that can be readily implemented to improve the safety of CT-guided percutaneous lung biopsy .