Roua BenAyed

Background/Objectives: The aims of this study were to re-evaluate the necessity routine post-biopsy chest X-rays by evaluating the incidence, timing, and clinical relevance of pneumothorax (PTX) following CT-guided lung biopsies, and to determine whether symptom-based monitoring can safely replace routine imaging. Methods: This retrospective, single-center study included 112 patients (mean age: 69.3 years; 55% male) who underwent CT-guided lung biopsy between 9 January 2020 and 16 April 2025. PTX occurrence was assessed both intraprocedurally and during follow-up within 7 days. The primary outcome was the development of PTX; secondary outcomes were chest drainage need and delayed PTX identification. Logistic regression analysis and descriptive statistics were used to identify predictors and associations. Results: Intra-procedural PTX occurred in 43.8%, of whom 10.7% required immediate drainage. Clinically silent PTX that did not require intervention occurred in 25.9%. Routine chest X-rays were obtained 4 h post-biopsy for all patients. Importantly, no asymptomatic patient required any intervention. These results suggest that routine 4 h imaging may be unnecessary in the absence of symptoms. Conclusions: PTX is frequent after CT-guided lung biopsy but is often asymptomatic and self-limiting. The absence of clinically significant findings among asymptomatic patients supports a shift toward symptom-based monitoring. Implementing this strategy may help reduce unnecessary post-biopsy imaging and optimize healthcare resource utilization without compromising patient safety.

Background: Pneumothorax (PTX) is the most common complication of CT-guided lung biopsies. New technical advances, namely the optimization of needle approach angles within an a priori defined “safe zone,” are intended to reduce this risk. This study evaluates whether PTX incidence and chest tube placement decreased significantly after these technical advances were implemented. Methods: We retrospectively analyzed 118 consecutive patients who had undergone CT-guided lung biopsy between 9 January 2020, and 4 April 2025. The study was divided into three periods of increasingly growing institutional procedural experience: Pre-Knowledge (January 2020–March 2022; n = 45), Partial Knowledge (April–December 2022; n = 18), and Full Knowledge (January 2023–April 2025; n = 55). PTX incidence and chest tube use were compared across periods using chi-square and Fisher’s exact tests, while Kaplan–Meier survival analysis was used to evaluate PTX-free survival over time. Results: Overall PTX incidence significantly declined from 71.1% in the Pre-Knowledge Period to 21.8% in the Full Knowledge Period (p < 0.000001). Rates of chest tube placements also decreased from 17.8% to 9.1%, although this difference was not statistically significant (p = 0.372). Kaplan–Meier analysis showed a statistically significant improvement in PTX-free survival over time (indicating improvement in the timing of complication onset; p = 0.0042). Procedural optimization was also fostered by a large median intrapulmonary needle length and consistent needle angulation within the safe zone. Conclusions: Formal implementation of needle angle optimization and procedural protocol standardization has effectively reduced the frequency and severity of PTX following CT-guided lung biopsies. These results highlight the benefit of continuous education and technique standardization in improving patient safety and clinical outcomes.