Effectiveness and Safety of Percutaneous Image-Guided Lung Biopsies: Analysis of 27559 Procedures from the German Society for Interventional Radiology and Minimally Invasive Therapy Registry

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Abstract
Image-guided lung biopsies play a key role in diagnosing pulmonary lesions. However, comprehensive safety and efficacy data remain limited. As lung screening expands across Europe, more indeterminate nodules require histologic clarification. This study evaluates technical success, diagnostic yield, and complications based on registry data from the German Society for Interventional Radiology and Minimally Invasive Therapy (DeGIR). A total of 27559 image-guided lung biopsies from 212 centers (2018–2024) were analyzed. Technical success was defined as verified needle placement and diagnostic yield as adequate histological sampling. Complications were classified by the Society of Interventional Radiology (SIR) criteria. Most biopsies (95.9%) were inpatient. Local anesthesia was used in 97.5% of cases. CT guidance was used in 99.4% of cases. Technical success was 97.7%, and the diagnostic yield was 94.3%. Inpatient procedures showed slightly higher technical success rates (97.8% vs. 96.8%, p = 0.032), while the diagnostic yield was similar (94.3% vs. 92.9%, p = 0.063). Overall complications occurred in 19.4% of cases, major complications in 4.9% of cases and mortality in 0.06%. Coagulation disorders increased risk. Image-guided lung biopsies are effective, with high success and diagnostic yield. However, complication rates were substantial, with nearly 20% overall and 5% major events. Careful patient selection and individualized risk stratification are essential to optimize procedural safety.

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