Impact of Technical Standardization on Pneumothorax and Chest Tube Insertion Rates: A Retrospective Learning Curve Analysis of CT-Guided Lung Biopsies

Background: Pneumothorax (PTX) is the most common complication of CT-guided lung biopsies. New technical advances, namely the optimization of needle approach angles within an a priori defined "safe zone," are intended to reduce this risk. This study evaluates whether PTX incidence and chest tube placement decreased significantly after these technical advances were implemented. Methods: We retrospectively analyzed 118 consecutive patients who had undergone CT-guided lung biopsy between 9 January 2020, and 4 April 2025. The study was divided into three periods of increasingly growing institutional procedural experience: Pre-Knowledge (January 2020-March 2022; n = 45), Partial Knowledge (April-December 2022; n = 18), and Full Knowledge (January 2023-April 2025; n = 55). PTX incidence and chest tube use were compared across periods using chi-square and Fisher's exact tests, while Kaplan-Meier survival analysis was used to evaluate PTX-free survival over time. Results: Overall PTX incidence significantly declined from 71.1% in the Pre-Knowledge Period to 21.8% in the Full Knowledge Period (p < 0.000001). Rates of chest tube placements also decreased from 17.8% to 9.1%, although this difference was not statistically significant (p = 0.372). Kaplan-Meier analysis showed a statistically significant improvement in PTX-free survival over time (indicating improvement in the timing of complication onset; p = 0.0042). Procedural optimization was also fostered by a large median intrapulmonary needle length and consistent needle angulation within the safe zone. Conclusions: Formal implementation of needle angle optimization and procedural protocol standardization has effectively reduced the frequency and severity of PTX following CT-guided lung biopsies. These results highlight the benefit of continuous education and technique standardization in improving patient safety and clinical outcomes.