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PLoS One. 2019 Mar 18;14(3):e0213990. doi: 10.1371/journal.pone.0213990. eCollection 2019.

Complications of CT-guided lung biopsy with a non-coaxial semi-automated 18 gauge biopsy system: Frequency, severity and risk factors.

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Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.
German Centre for Lung Research, Hannover, Germany.
Institute of Diagnostic and Interventional Radiology, Faculty of Medicine Mansoura University, Mansoura, Egypt.
Institute for Biostatistics, Hannover Medical School, Hannover, Germany.



To evaluate frequency and severity of complications after CT-guided lung biopsy using the Society of Interventional Radiology (SIR) classification, and to assess risk factors for overall and major complications.


311 consecutive biopsies with a non-coaxial semi-automated 18 gauge biopsy system were retrospectively evaluated. Complications after biopsy were classified into minor SIR1-2 and major SIR3-6. Studied risk factors for complications were patient-related (age, sex and underlying emphysema), lesion-related (size, location, morphologic characteristic, depth from the pleura and histopathology), and technique-related (patient position during procedure, thoracic wall thickness at needle path, procedure time length and number of procedural CT images, number of pleural passes, fissure penetration and needle-to-blood vessel angle). Data were analyzed using logistic and ordinal regression.


Complications were pneumothorax and pulmonary hemorrhage. The complications were minor SIR1-2 in 142 patients (45.6%), and major SIR3-4 in 25 patients (8%). SIR5-6 complications were not present. Emphysema, smaller deeply located lesion, increased puncture time length and number of procedural CT images, multiple pleural passes and fissure puncture were significant risk factors for complication severity in univariate analysis. Emphysema (OR = 8.8, p<0.001), lesion depth from the pleura (OR = 1.9 per cm, p<0.001), and fissure puncture (OR = 9.4, p = 0.01) were the independent factors for major complications in a multiple logistic regression model. No statistical difference of complication rates between the radiologists performing biopsies was observed.


Knowledge about risk factors influencing complication severity is important for planning and performing CT-guided lung biopsies.

Conflict of interest statement

The authors have declared that no competing interests exist.

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