The risk of immediate pneumothorax after CT-guided lung needle biopsy: pleural tail sign as a novel factor

Background: Pneumothorax is the most frequent complication in computed tomography-guided lung needle biopsy (CT-LNB) and generally appears immediately or within an hour after CT-LNB. Preventing pneumothorax after CT-LNB requires a preoperative evaluation of risk factors. This study investigated risk factors for the occurrence of immediate pneumothorax after CT-LNB. Methods: A total of 311 CT-LNB procedures were conducted for 290 patients (217 males and 73 females) with persistent solid or part-solid pulmonary lesions in this case-control study. We retrospectively evaluated immediate postbiopsy pneumothorax complications and associated risk factors. The possible risk factors for immediate pneumothorax were analyzed, including 12 parameters in demographics, radiological features, and procedural factors. Univariate and multivariate logistic regression analyses were used to investigate independent risk factors for the occurrence of immediate pneumothorax after CT-LNB. Results: All CT-LNB procedures (100%) were technically successful. Immediate pneumothorax after CT-LNB occurred in 115 out of the 311 procedures (36.9%). Chest tube placement was required for 12.2% (14/115) of the pneumothoraces (14/311, 4.5% of the total number of CT-LNB procedures). The other pneumothoraces were treated conservatively. Independent risk factors of immediate pneumothorax included a lesion with pleural tail sign [PTS; odds ratio (OR) =3.021, 95% confidence interval (CI): 1.703-5.359; P<0.001], smaller lesion size (OR =0.827, 95% CI: 0.705-0.969; P=0.019), a lesion in the middle or lower lobe (OR =2.237, 95% CI: 1.267-3.951; P=0.006), a higher number of pleural punctures (OR =2.710, 95% CI: 1.399-5.248; P=0.003), and a deep-seated lesion (OR =1.622, 95% CI: 1.261-2.088; P<0.001). Conclusion: PTS is a novel risk factor for immediate pneumothorax and may increase the immediate pneumothorax rate after CT-LNB. Practitioners should be vigilant of the risk of immediate pneumothorax after CT-LNB in lung lesions with PTS.