Risk of Complications in Computed Tomography–Guided Lung Biopsy Is Dwell Time and Needle: Pleural Angle Contributing Factors?

Background: CT-guided lung biopsy is a well-established method in the diagnosis of lung lesions; however, it comes with a few known complications. This study was done to evaluate the rate of complications and assess the influence of various variables on the occurrence of pneumothorax and pulmonary hemorrhage in CT-guided transthoracic needle biopsy.

Materials and Methods: This prospective study involved 40 patients who had indeterminate pulmonary nodule/mass on chest X-ray/CT and underwent CT-guided transthoracic lung biopsy using coaxial biopsy set in our hospital. Incidence of postprocedure complications, like pneumothorax and pulmonary hemorrhage, was seen and the effect of various patient, lesion, and procedure-related factors on the frequency of complications was evaluated. Special emphasis on procedural factors, like dwell time and needle-pleural angle, was analyzed. The risk factors were determined using univariate analysis of variables

Results: Pneumothorax occurred in 22.5% (9/40) of patients. The risk factors associated with postbiopsy pneumothorax were depth from pleura (p = 0.049), dwell time (p = 0.001), and needle pleural angle (p = 0.020). Pulmonary hemorrhage occurred in 35% (14/40) of patients. Increased incidence of pulmonary hemorrhage had a statistically significant correlation with dwell time (p = 0.023), depth from pleura (p = 0.041), and patients in supine position (p = 0.05).

Conclusion: This study demonstrated a significant effect of the depth of the lesion, needle-pleural angle, and dwell time on the incidence of postprocedural pneumothorax. Needle gauge, emphysema, gender of the patient, site of the lesion, and operator experience had no effect on complication rate. The needle should be as perpendicular as possible to the pleura (needle-pleural angle close to 90 degrees), to minimize the possibility of pneumothorax after transthoracic needle biopsy.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
14 December 2021