Subpleural injection of gelatin sponge particles to reduce pneumothorax incidence in CT-guided lung biopsies: a retrospective single-center case-control study

Background To evaluate the efficacy and safety of track sealing using subpleural injection of gelatin sponge particles in reducing the incidence of pneumothorax after percutaneous CT-guided lung biopsy. Methods This study conducted a retrospective analysis of 1,026 patients who underwent CT-guided lung biopsy at our center from January 2022 to July 2024. After propensity score matching (PSM) to minimize the impact of confounding variables like smoke, lesion diameter, and tract length, 338 patients were ultimately included and assigned to the sealant group (169 patients) or the non-sealing group (169 patients) according to whether using the gelatin sponge particles sealing after needle withdraw to the subpleural area. Clinical and operative characteristics data were collated from electronic medical records (EMR) and Picture Archiving and Communication Systems (PACS). A multivariable logistic regression analysis was conducted to identify predictors of pneumothorax. Results In the sealing group, the incidence of pneumothorax was 14.8%, whereas it was significantly higher in the non-sealing group at 23.7% (p < 0.05). There was no significant difference in the chest tube placement rates of 3% and 1.8% (p = 0.723). Importantly, no significant complications, such as air embolism, were observed in either group. A multivariate logistic regression analysis, using a propensity score-matched cohort, identified patient emphysema (OR = 2.35 [1.22-4.51], p = 0.01) and the tract length (OR = 1.25 [1.01-1.55], p = 0.042) as significant risk factors for pneumothorax. Furthermore, gelatin sponge particle needle-tract sealing demonstrated a marked and statistically significant reduction in the risk of pneumothorax (OR = 0.5 [0.27-0.91], p = 0.024), highlighting the distinct advantages and clinical value of this treatment in preventing such complications. Conclusions The gelatin sponge particle subpleural sealing technique can effectively reduce the incidence of pneumothorax in patients undergoing percutaneous CT-guided lung biopsy.