Extrapleural Saline Hydrodissection Before CT-Guided Lung Biopsy to Reduce Pneumothorax: A Prospective Comparative...

To evaluate whether extrapleural saline hydrodissection (EPSH) performed before CT-guided percutaneous transthoracic needle biopsy (PTNB) reduces pneumothorax in pleura-adjacent lung lesions.

In this prospective study, 90 patients with pulmonary lesions ≤1.5 cm from the pleura underwent CT-guided PTNB and were assigned to standard PTNB (Group 1, n = 45) or PTNB with EPSH (Group 2, n = 45). Demographic, lesion-related, procedural variables and complications were compared. Multivariable logistic regression evaluated the effect of EPSH on pneumothorax. In Group 2, lesions were stratified by pleura-lesion distance (≤5 mm, >5-10 mm, >10-15 mm); pre- and post-EPSH distances were compared.

Procedure time (16.9 ± 4.5 vs. 23.4 ± 4.4 min), radiation dose (105.7 ± 41.5 vs. 124.6 ± 44.5 mGy·cm), and CT acquisitions (5.2 ± 1.4 vs. 6.0 ± 1.4) were higher in Group 2 (all p ≤ 0.015). Pneumothorax was less frequent after EPSH-assisted PTNB (26.7% vs. 8.9%, p = 0.027), corresponding to an absolute risk reduction 17.8% and number needed to treat of 6; none required intervention. Group 1 showed higher pneumothorax odds than Group 2 (OR 4.68, 95% CI 1.24-17.65; p = 0.023). Other procedural parameters were similar. EPSH significantly reduced pleura-lesion distance in all subgroups (p < 0.05), minimizing aerated lung in lesions ≤5 mm.

EPSH was associated with significantly lower pneumothorax rates during CT-guided PTNB despite increased procedural demands, with greatest benefit in lesions ≤5 mm from the pleura.