Complications of CT-Guided Percutaneous Lung Biopsy: A 1-Year Single-Center Experience in Iran

Despite observing all precautions, complications are not uncommon during transthoracic needle biopsy (TTNB). We aimed to evaluate the complications associated with TTNB in patients with lung masses from 1 center in southern Iran.

In this retrospective cohort study, data on complication rates, types, and potential risk factors from 87 biopsies were collected. Complications were assessed through immediate post-biopsy computed tomography (CT) scans and follow-up chest X-rays, and their correlations were evaluated with patient demographics, lesion characteristics, and procedural factors. Chi-square and Wilcoxon rank-sum tests were used for univariable analysis, and multivariable binary logistic regression analyses were conducted to control for potential confounders.

The overall complication rate was 37.9% (95% CI, 27.6%-48.3%), with pneumothorax being the most common, occurring in 26.4% (95% CI, 17.3%-35.6%) of cases, followed by perilesional hemorrhage (17.2%) (95% CI, 10.3%-25.3%), hemoptysis (3.3%), and pleural effusion (1.1%). All pneumothorax cases were identified via immediate post-biopsy CT, and only 1 patient required chest tube insertion. No significant correlations were found between age, sex, presence of emphysema, lesion size, location, and depth, or needle path and the incidence of pneumothorax. However, a significantly higher perilesional hemorrhage incidence was observed for smaller lesion size (26 mm [interquartile range, IQR], 13,40 vs 43 mm [IQR, 24,73]; P = 0.019), deeper lesion (10 mm [IQR, 0.17] vs 0 mm [IQR, 0.10]; P = 0.041), and longer needle path (17 mm [IQR, 9.29] vs 0 mm [IQR, 0.7]; P < 0.001). Furthermore, 47.8% of pneumothorax cases identified on postbiopsy CT showed no signs on follow-up chest X-ray 3 hours later.

TTNB is generally safe, with a manageable complication profile. Early detection and appropriate follow-up are crucial, particularly for pneumothorax, which often resolves spontaneously. The findings underscore the importance of considering lesion characteristics to minimize complications during biopsy procedures.