Factors Influencing Diagnostic Yield and Complication Risk in CT-Guided Transthoracic Lung Biopsy of Pulmonary Lesions: A Retrospective Analysis

Background/Objectives: CT-guided transthoracic lung biopsy is a broadly performed and minimally invasive procedure for obtaining tissue samples from pulmonary lesions, offering a high diagnostic yield, and remains a cornerstone of accurate lung cancer diagnosis. The primary objective of this study was to assess the diagnostic yield of CT-guided transthoracic lung biopsies and to investigate the factors influencing this yield, with procedure-related complications being a secondary objective. Methods: A retrospective study was conducted on 356 CT-guided transthoracic lung biopsies performed between January 2021 and December 2023. The patient demographics, lesion characteristics (size, location) and histological findings were analyzed. The diagnostic yield was evaluated based on histological findings and, if necessary, follow-up information. Results: Of the 356 biopsies, 326 (91.6%) were found to be diagnostic, and 30 (8.4%) were non-diagnostic. The diagnostic yield was significantly influenced by lesion size and the number of biopsy cores, with lesions ≤2 cm associated with a higher diagnostic failure rate (p = 0.034). A significant interaction was also observed between lesion size and core number (p < 0.001). The overall complication rate was 11.5%, with pneumothorax being the most frequent event (7.0%). CIRSE grade 2 and grade 3 complications occurred in 4.8% and 3.1% of cases, respectively. Solid lesion morphology was identified as an independent predictor of complications (OR = 1.67, p = 0.022). Conclusions: In summary, CT-guided transthoracic lung biopsy demonstrates a high diagnostic yield with an acceptable safety profile and remains an important diagnostic tool in the evaluation of pulmonary lesions.