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

Sep 29, 2026

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Computed tomography fluoroscopy (CTF)-guided biopsy is used to sample pulmonary lesions, especially as lung nodule screening expands. This 10-year single-center retrospective analysis evaluated procedural and lesion-related factors that affect technical and clinical success and complication rates in routine CT fluoroscopy-guided lung core-needle biopsies. Across 641 patients, success was high while major complications occurred in 11%, mainly pneumothorax. Risk increased with small lesions and greater pleura-to-lesion distance, with emphysema-related changes contributing.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages11

Reading Time28 min

AccessFree to download

Purpose

Methods

Results

Success and complications

Predictors of complications and biopsy failure

Conclusion

Clinical Significance

Keywords

Copyright @ 2026 Author(s) -[Available online at dirjournal.org.](Available online at dirjournal.org. ORIGINAL)[ ORIGINAL](Available online at dirjournal.org. ORIGINAL) ARTICLE Content of this journal is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. Factors influencing diagnostic yield and complication risk in computed tomography fluoroscopy-guided lung biopsies: a 10-year single-center study Nabeel Mansour 1 Hannah Gildein1 Frederik F. Strobl2 Osman Öcal1,3 Tobias Geith4 Daniel Puhr-Westerheide1 Matthias Stechele1 Sinan Deniz 1 Muzaffer R. Ümütlü1 Nicola Fink1 Dirk Mehrens1 Moritz Wildgruber 1 Max Seidensticker1 Maximilian F. Reiser 1 Jens Ricke1 Philipp M. Paprottka4\# Matthias P. Fabritius1\# 1LMU University Hospital, LMU Munich, Department of Radiology, Munich, Germany 2DIE RADIOLOGIE, Munich, Germany 3Heidelberg University Hospital, Department of Diagnostic and Interventional Radiology, Heidelberg, Germany 4University Hospital Klinikum Rechts Der IsarTUM, School of Medicine, Technical University of Munich, Department of Interventional Radiology, Munich, Germany \#Contributed equally Corresponding author: Nabeel Mansour [E-mail:](E-mail: Nabeel.Mansour@med.uni-muenchen.de)[ Nabeel.Mansour@med.uni-muenchen.de](E-mail: Nabeel.Mansour@med.uni-muenchen.de) Received 04 June 2025; revision requested 12 July 2025; accepted 28 July 2025. 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. KEYWORDS Biopsy, computed tomography, fluoroscopy, interventional, lung Epub: 11.09.2025 Public

FAQs

What was the purpose of this study on CTF-guided lung biopsies?

To identify procedural and lesion-related factors influencing diagnostic success and complication rates in routine computed tomography fluoroscopy-guided lung core-needle biopsies at a tertiary center.

How were patients and data analyzed in the study?

Consecutive patients undergoing percutaneous CTF-guided lung biopsies over 2007–2016 were retrospectively analyzed, collecting lesion and procedural characteristics plus technical/clinical outcomes and complications. Multivariable logistic regression was used to identify independent predictors.

What factors were associated with major complications, particularly pneumothorax?

Major complications occurred in 11% and were primarily pneumothorax-related. Independent risk factors included smaller lesion size and greater pleura-to-lesion distance, and major events were associated with longer intrapulmonary needle tract, greater pleura-to-lesion distance, fissure crossing, and emphysema or subpleural air cysts.

Sep 29, 2026

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