Factors influencing diagnostic yield and complication risk in computed tomography fluoroscopy-guided lung biopsies: a 10-year single-center study.

Purpose: Computed tomography fluoroscopy (CTF)-guided biopsy is an established technique for sampling pulmonary lesions, particularly with the growing prevalence of lung nodule screening programs. This study investigated procedural and lesion-related factors affecting success and complication rates in routine CTF-guided lung core-needle biopsies at a tertiary center.

Methods: Consecutive patients undergoing percutaneous CTF-guided lung biopsies over a 10-year period (2007-2016) were retrospectively analyzed. Data collected included lesion characteristics, procedural details, and outcomes, including technical and clinical success and complications. Multivariable logistic regressions were used to identify predictors of complications and biopsy failure.

Results: Among 641 patients (43% female; median age 67 years) with a median lesion size of 3.1 cm, technical and clinical success rates were 99% and 93%, respectively. Clinical success was associated with multiple pulmonary lesions and longer specimen length, with multivariable analysis identifying multiple lesions as the sole independent predictor [odds ratio (OR): 2.4]. Major complications (n = 70, 11%), primarily pneumothorax (n = 62, 90%), were associated with a longer intrapulmonary needle tract, greater pleura-to-lesion distance, smaller lesion size, fissure crossing, and the presence of emphysema or subpleural air cysts. Multivariable analysis identified smaller lesion size (OR: 0.8) and greater pleura-to-lesion distance (OR: 1.5) as independent risk factors.

Conclusion: CTF-guided lung biopsy is a safe and effective method for tissue sampling with high diagnostic success rates. Although multiple samples do not increase the risk of major complications, factors such as small lesion size, greater pleura-to-lesion distance, and emphysema-related changes are associated with a higher incidence of pneumothorax, emphasizing the need for risk-aware procedural planning.

Clinical significance: CTF-guided lung biopsy demonstrates high diagnostic performance in routine practice. Understanding how specific anatomical features influence complication risk can guide radiologists in selecting safer biopsy approaches, especially in patients undergoing evaluation through lung cancer screening programs. Integrating these risk factors into procedural planning supports more informed, patient-centered decision-making in routine clinical practice.