The Interplay of Time and Angle with the Incidence of Pneumothorax in Computed Tomography-Guided Lung Biopsy

Pneumothorax remains one of the most common complications of computed tomography (CT)-guided lung biopsy, highlighting the importance of investigating contributing factors. This study assessed the interplay between the needle-pleura angle and the biopsy needle traversal duration (NTD) through the lung parenchyma during CT-guided lung biopsies that resulted in pneumothorax.In this retrospective study, 96 patients underwent CT-guided lung biopsies. The minimum delta (δmin) was calculated as the absolute value of the difference between a 90° angle and the measured angles of the needle with respect to the pleura, and correlations with the occurrence of pneumothorax were analyzed. The NTD was recorded from the moment of needle puncture through the pleura until needle retraction. Patients with pneumothorax were grouped on the basis of NTD: < or > 6 minutes. A multivariate analysis was conducted, comparing four patient groups with and without pneumothorax.6 out of 96 patients undergoing CT-guided lung biopsies were excluded because of predefined exclusion criteria. 22 patients experienced postprocedural pneumothorax-6/22 patients had δmin > 10° with NTD > 6 minutes, 5/22 had δmin < 10° with NTD < 6 minutes, 2/22 had δmin > 10° with NTD < 6 minutes, and 9/22 had δmin < 10° with NTD > 6 minutes. Overall, 14.7% of patients with δmin < 10° and NTD < 6 minutes experienced pneumothorax compared with 33.3% of patients with δmin > 10° with NTD > 6 minutes.Optimizing the needle-pleura angle and NTD during a CT-guided lung biopsy can reduce the risk of pneumothorax. · Pneumothorax is the most common complication of lung biopsies.. · Needle angle und needle-traversal duration can affect the incidence of pneumothorax.. · Needle-pleura angle and the needle-traversal duration can reduce the risk of pneumothorax.. · Maalouf N, Abou Mrad M, Benayed R et al. The Interplay of Time and Angle with the Incidence of Pneumothorax in Computed Tomography-Guided Lung Biopsy. Rofo 2025; DOI 10.1055/a-2594-7226.