Procedural Optimization in CT-Guided Lung Biopsy: Impact of Needle Angle and Patient Positioning on Complication Rates.

Background/Objectives: CT-guided lung biopsy is an essential diagnostic procedure but is associated with complications such as pneumothorax and pulmonary hemorrhage. While patient- and lesion-related factors are well established, operator-modifiable parameters remain less clearly defined. This study aimed to evaluate complication rates and identify independent predictors, with a particular focus on modifiable procedural factors. Methods: This retrospective study included 309 consecutive patients undergoing CT-guided transthoracic lung biopsy. Patient, lesion, and procedural variables-including needle-pleura angle and patient positioning-were analyzed. Complications were classified according to the Society of Interventional Radiology (SIR) system. Multivariate logistic regression analyses were performed to identify independent predictors. Results: Complications occurred in 20.4% of patients, with pneumothorax (14.2%) and hemorrhage (4.9%) being the most frequent. A needle angle ≤ 65° was independently associated with major complications (OR = 8.12, p = 0.025). Perilesional emphysema (OR = 19.38, p = 0.004) and pleural effusion (OR = 30.72, p = 0.001) were also strong predictors. Supine positioning significantly increased hemorrhage risk (OR = 9.03, p = 0.043). Conclusions: Operator-modifiable factors, particularly needle angle and patient positioning, may influence complication risk. Optimization of these parameters may provide a practical approach to improving procedural safety in CT-guided lung biopsy.