Pneumothorax after percutaneous CT-guided lung nodule biopsy: a prospective, multicenter study

Area of Science:

• Pulmonology
• Radiology
• Thoracic Surgery

Background:

• Pneumothorax is a frequent complication of computed tomography (CT)-guided percutaneous needle biopsy of lung nodules.
• Predicting and preventing post-biopsy pneumothorax remains a clinical challenge.
• This study investigates real-world factors associated with pneumothorax following lung nodule biopsy.

Purpose of the Study:

• To identify clinical and technical characteristics associated with pneumothorax after CT-guided percutaneous lung nodule biopsy.
• To evaluate the incidence and risk factors of pneumothorax in a real-world clinical setting.
• To provide insights for predicting and potentially preventing post-biopsy pneumothorax.

Main Methods:

• A clinical registry cohort study involving 593 patients undergoing percutaneous lung nodule biopsy across 10 medical centers.
• Data collected included patient demographics, nodule imaging features, and percutaneous biopsy technical factors.
• Statistical analysis involved t-tests, ANOVA, Chi-square tests, and multivariate logistic regression to identify risk factors.

Main Results:

• The overall incidence of pneumothorax was 13.0%, with 10.3% occurring timely and 2.7% delayed.
• Increased pneumothorax morbidity correlated with older age, emphysema, and longer operation time.
• Multiple pleural passes (≥3) significantly increased pneumothorax risk (P=0.022), while 1-2 passes showed no significant increase (P=0.062).
• A 17G needle was associated with a lower incidence of pneumothorax compared to 18G needles.

Conclusions:

• Pneumothorax is a manageable complication, often treated conservatively.
• Limiting pleural passes to a maximum of two appears safe.
• The 17G needle may be a preferable choice for percutaneous lung nodule biopsy to reduce pneumothorax risk.