Comparison of Adverse Events between Computed Tomography-guided Core Needle Biopsy and Fine-needle Aspiration of Pulmonary Lesions: A Single-center Experience

Abstract Context: Peripheral pulmonary lesions may undergo either computed tomography (CT)-guided core needle biopsy (CNB) or fine needle aspiration (FNA); choosing between them is often driven by safety concerns as much as diagnostic yield. Aim: We analyzed the differences and predictors of procedure-related adverse events (AE) between CNB and FNA. Settings and Design: This was a single-center, retrospective observational study. Materials and Methods: This study included patients with pulmonary lesions who underwent CT-guided FNA, CNB or both. Biopsy-related AE, including pulmonary hemorrhage, pneumothorax, and the need for chest tube placement, were assessed as the outcomes. Statistical Analysis Used: Comparisons between FNA and CNB were conducted using Chi-square and t -tests, with multivariate logistic regression identifying independent predictors of AEs (odds ratio [OR] >1.0). Statistical significance was set at P < 0.05. Results: Among 160 patients (53.8% male; mean age: 64.2 ± 12.5 years), 56 had FNA and 104 CNB. Pneumothorax occurred in 23.1% overall (FNA: 17.85% vs. CNB: 25.96%, P = 0.24); most were mild (19.38%). Hemorrhage was more frequent with CNB (24.04% vs. 10.71%, P = 0.042). CNB independently increased overall AE risk (OR: 2.22; 95% confidence interval [CI]: 1.11–4.46; P = 0.02) and hemorrhage (OR: 2.63; 95% CI: 1.01–6.87; P = 0.04). Conclusion: Pneumothorax rates were similar between CNB and FNA. However, CNB was associated with a higher risk of hemorrhage and overall AE. In selected patients, FNA may offer a safer alternative with comparable diagnostic yield when performed by an experienced radiologist.