Risk Factors of Pneumothorax after CT-Guided Coaxial Cutting Needle Lung Biopsy through Aerated versus Nonaerated Lung

Purpose: To compare the risk factors of developing a pneumothorax after computed tomography guided lung biopsy in cases in which aerated lung is traversed and in cases in which aerated lung is not traversed. Materials and Methods: The records of 381 patients from July 2005 December 2009 were retrospectively reviewed. Multivariable analysis of patient demographic characteristics, lung lesion characteristics, and biopsy procedure details was performed with respect to the development of pneumothorax. Results: Among 381 patients, 249 biopsies traversed aerated lung tissue, and 132 biopsies did not traverse aerated lung tissue. Patients in whom aerated lung tissue was traversed had a significantly higher rate of pneumothorax. When aerated lung was not traversed, lesion size (<= 2 cm vs > 2 cm; P = .025) and pleural-lesion angle (odds ratio = 1.033/degree; P = .004) were associated with pneumothorax. When aerated lung was traversed, location (middle vs upper; P = .009) and a transfissure approach (yes vs no; P = .001) were associated with pneumothorax. Conclusions: When aerated lung was not traversed, lesion size and pleural-lesion angle were associated with pneumothorax, and when aerated lung was traversed, location and a transfissure approach were associated with pneumothorax.