Navigating Biopsy Safety: Complication Rates Under Ultrasound and CT Guidance

<b>Background/Objectives:</b> The frequency of image-guided biopsies has increased substantially in recent decades; however, high technical success rates are offset by potential complications. <b>Methods:</b> This retrospective study compared the safety profile of ultrasound- and CT-guided percutaneous biopsies in 250 patients involving the liver, thoracic organs, retroperitoneum, peripheral lymph nodes, and bone. The parameters analyzed included procedure duration, technical success, as well as type, frequency, severity, timing, and treatment of complications. Statistical comparisons comprised Mann-Whitney-U and Chi-square tests. <b>Results:</b> The overall technical success rate was 97.6%, with no significant difference between CT and ultrasound (<i>p</i> = 0.491). Ultrasound-guided biopsies were performed more often in women; CT-guided procedures were performed more often in men (<i>p</i> = 0.031). Ultrasound-guided interventions were significantly faster with a median duration of 19:00 min vs. 25:30 min in CT (<i>p</i> < 0.001). Median radiation dose for CT-guided procedures was 445 mGy·cm (interquartile range 307.8-634.0). Including minor events, complications occurred in 19.6% of cases. Complication rates were significantly higher for CT- (30.3%) compared to ultrasound-guided biopsies (7.6%; <i>p</i> < 0.001). Bleeding and pneumothorax were significantly more frequent in CT-guided interventions (<i>p</i> = 0.004). Most complications were mild (85.7%) with no life-threatening events. The majority of complications occurred within four hours post-biopsy (93.9%). The severity of complications did not differ significantly between modalities (<i>p</i> = 0.399). <b>Conclusions:</b> CT-guided biopsies were associated with higher complication rates, likely reflecting procedural complexity and better detection of minor complications. Post-interventional complications such as pneumothorax and bleeding were mostly mild, while severe complications occurrence was extremely rare.