Safety and Efficacy of CT-Guided Lung Biopsy in Elderly Patients age 75 Years and Older: A Single-Centre Retrospective Comparative Study

Introduction CT-guided biopsy has good diagnostic accuracy, but adverse events such as pneumothorax are common. There are few reports on the safety and efficacy of CT-guided biopsy in the elderly. Methods This was a retrospective single-centre cohort study. Patients who underwent CT-guided lung biopsy between February 2017 and August 2024 were included. Patient background, disease background, examination status, and adverse events were ascertained. Elderly were defined as those aged 75 years and older. The primary outcome was the incidence of all adverse events, and the secondary outcomes were the incidence of pneumothorax and diagnostic accuracy. Categorical variables were compared by Chi-square test, and continuous variables by t-test. Multivariable analysis was performed by logistic regression analysis adjusted for age, sex, lung comorbidities, and radiological findings of target lesion. Results There were significant differences between the two groups in ECOG-PS and the distance from the surface to pleura and target. In the primary outcome, any adverse events occurred in 207 patients (56.2%), with no significant difference between elderly (97/180, 53.9%) and non-elderly (110/188, 58.5%) patients ( p = 0.401). Pneumothorax was the most common adverse event, occurring in 151 (41.0%) patients, with no significant difference between elderly (68/180, 37.8%) and non-elderly (83/188, 44.1%) ( p = 0.244). On multivariate analysis, elderly (75years or older) was not clearly associated with the occurrence of all or severe adverse events, pneumothorax, and confirmed diagnosis. Location in the lower lung field and distant from the pleura were significantly associated with the incidence of all adverse event. In the secondary outcomes, emphysema or interstitial pneumonia, location in the lower lung field, and distant from the pleura were significantly associated with pneumothorax. There was no significant difference in the diagnostic accuracy disease between the elderly and non-elderly patients. Conclusions The incidence of adverse events and diagnostic accuracy of CT-guided biopsy are similar in elderly and non-elderly patients, and this method is useful even in elderly patients. Key point The safety and efficacy of CT-guided lung biopsy in elderly patients are equivalent to those in non-elderly patients.