Reducing Lung Biopsy Complications with Saline Injection: Evidence from a CT-Guided Cohort Study

Purpose: In this study, our aim is to assess the efficacy of saline-assisted needle withdrawal in minimizing pneumothorax and bleeding complications during CT-guided lung biopsies. Methods: In this retrospective study, 400 patients who underwent CT-guided lung biopsy were divided into two groups: 200 patients underwent conventional needle withdrawal (control group), and the other 200 patients underwent saline-assisted needle withdrawal (NaCl group). Needle angle, patient positioning, demographic data, and other procedural variables were collected. The primary outcome was the incidence of pneumothorax; secondary outcomes included bleeding rates and the impact of procedural factors on complication risk. Statistical analyses included Chi-square tests, logistic regression, and multinomial modeling. Results: The NaCl group demonstrated a significantly lower incidence of clinically significant pneumothorax (13.5%) compared to the control group (22.0%) (p = 0.007), while bleeding complications occurred in 26.5% of patients in the former versus 45.0% in the latter (p < 0.001). Multivariate analysis suggested a non-significant trend toward a higher pneumothorax risk with shallow needle angles (<60°; p = 0.502). Saline injection was especially advantageous in patients with underlying lung disease, reducing pneumothorax severity even when overall incidence rates were similar. No adverse events were attributed to the use of saline. Conclusions: Saline-assisted tract sealing is a safe and cost-effective technique that significantly reduces the risk of clinically significant pneumothorax and bleeding in CT-guided lung biopsies. Due to its simplicity and favorable safety profile, this approach holds considerable promise for widespread clinical implementation.