Procedural Optimization in CT-Guided Lung Biopsy: Impact of Needle Angle and Patient Positioning on Complication...

Area of Science:

• Radiology
• Interventional Radiology
• Pulmonary Medicine

Background:

• CT-guided transthoracic lung biopsy is crucial for diagnosis but carries risks like pneumothorax and hemorrhage.
• While patient and lesion factors are known, operator-modifiable procedural factors require further investigation.
• Understanding these modifiable factors is key to enhancing procedural safety.

Purpose of the Study:

• To evaluate complication rates in CT-guided lung biopsies.
• To identify independent predictors of complications, focusing on operator-modifiable parameters.
• To assess the impact of needle-pleura angle and patient positioning on outcomes.

Main Methods:

• Retrospective analysis of 309 consecutive CT-guided transthoracic lung biopsies.
• Inclusion of patient, lesion, and procedural variables (needle-pleura angle, patient positioning).
• Multivariate logistic regression to identify independent predictors of complications classified by SIR criteria.

Main Results:

• Overall complication rate was 20.4%, with pneumothorax (14.2%) and hemorrhage (4.9%) most common.
• A needle angle ≤ 65° independently predicted major complications (OR=8.12, p=0.025).
• Supine positioning increased hemorrhage risk (OR=9.03, p=0.043), while perilesional emphysema and pleural effusion were strong predictors.

Conclusions:

• Operator-modifiable factors, specifically needle angle and patient positioning, significantly influence complication risk.
• Optimizing needle angle and patient positioning offers a practical strategy to enhance safety in CT-guided lung biopsies.
• Further research into procedural parameter optimization can lead to improved patient outcomes.