Complications of pneumothorax in computed tomography-guided transthoracic needle biopsy and prognostic factors: study on patients with tumor-like lung lesions

Background: Transthoracic biopsy has proven to be an effective procedure, especially for peripheral lung lesions, in obtaining samples that can definitively diagnose the underlying pathology. Despite its effectiveness, studies have demonstrated that it is associated with complications such as pneumothorax and hemoptysis. This study aims to evaluate the incidence of these complications and identify prognostic factors in patients who underwent a transthoracic biopsy.

Methods: This retrospective cohort analysis included adults from Thu Duc City Hospital, a sub-urban hospital who underwent transthoracic biopsy from 2017 to 2022. Complications that were evaluated included pneumothorax and hemoptysis. Separate logistic regression models estimated the association of pneumothorax or hemoptysis and selected baseline patient demographic and clinical characteristics.

Results: Among 221 patients who underwent transthoracic biopsy, 27.6% experienced pneumothorax complications, 19.9% had hemoptysis, and 5.4% had both. No air embolism was recorded. Most of the complications were mild and limited with medical management. Among patients who experienced pneumothorax, 6.6% (4/61) required chest tube drainage. Biopsy in tumors with a distance from chest wall to tumor edge of more than 20 mm and skin to tumor edge of more than 40 mm was associated with a higher risk of pneumothorax complication. Using the area under the receiver operating characteristic (AUROC) curve, a threshold of 23 mm for chest wall to tumor edge and 39.4 mm for skin to tumor edge could help predict pneumothorax with significant sensitivities and specificities.

Conclusions: This retrospective study demonstrated that approximately half of patients undergoing thoracic biopsy experienced complications. It was suggested that pneumothorax could be predicted by measuring the distance from the tumor edge to the chest wall and the skin to have better preoperation preparation and potentially mitigate the issue.