Computed Tomography-Guided Percutaneous Core Needle Biopsy of Lung Lesions: <i>Factors influencing diagnostic yield and complications</i>

Objectives: This study aimed to evaluate the diagnostic yield and complications associated with computed tomography (CT)-guided transthoracic core-needle biopsy (CNB) of lung lesions and to identify factors influencing biopsy outcomes. Methods: This retrospective study included patients who underwent CT-guided CNB of lung lesions at Sultan Qaboos Comprehensive Cancer Care & Research Centre, University Medical City, Muscat, Oman, from November 2021 to December 2024. Patients were categorised as either having undiagnosed lung masses/nodules or suspected pulmonary metastases from known malignancies. Biopsies were performed using an 18-gauge coaxial needle, following standard protocols. Diagnostic yield, sample adequacy for molecular analysis and complications were analysed using descriptive statistics and Chi-squared or Fisher's exact tests. Results: A total of 105 patients were included. Diagnostic yield of CT-guided CNB was 81.9% (n = 86) with malignancy confirmed in 72.4% of cases. Diagnostic yield significantly correlated with lesion size with increasing accuracy for lesions >2.1 cm compared to those <1 cm>(93.9% versus 55%; P = 0.003). Lesion morphology, localisation, positron emission tomography guidance and patient demographics had no significant effects statistically. Complications in 28.8% of patients were largely pneumothorax (21.2%), followed by haemoptysis (8.7%) and haemothorax (1.9%). Smaller lesions (<1 >cm) and deeper locations (>5 cm) had higher rates of complications (P = 0.007 and P = 0.080, respectively). Conclusion: CT-guided lung biopsy demonstrated high diagnostic yield with acceptable rates of complications. Lesion depth and size had significant impacts on diagnostic success and occurrence of complications. These results support that CT-guided CNB is a safe and reliable diagnostic procedure for lung lesions, especially when lung lesions are superficially located and solid.