Safety and Outcomes of Image-Guided Transthoracic Lung Biopsy: Experience from a Single-Center Cohort Study

Objective: Transthoracic needle biopsy (TTNB) under image guidance is a cornerstone technique for the diagnosis of pulmonary lesions. Despite its high diagnostic accuracy, procedure-related complications remain a concern. This study aimed to evaluate the safety, diagnostic yield, and complication profile of image-guided TTNB and to identify lesion-related factors influencing adverse outcomes.Materials and Methods: This single-center retrospective cohort study included 184 consecutive patients (143 males, 41 females; median age, 65 years) who underwent image-guided TTNB between January 2023 and May 2025. Most procedures (98.9%) were CT-guided, and a coaxial 17 G/18 G core needle technique was consistently used. Lesion characteristics, procedural parameters, and complications were recorded. Statistical analysis was performed to assess associations between lesion depth, size, and complication occurrence.Results: The diagnostic yield was 94.1%, with nondiagnostic samples in 5.9% of cases. Histopathological results revealed adenocarcinoma (29.3%), squamous cell carcinoma (12.5%), small-cell carcinoma (4.3%), metastatic tumors (4.9%), and benign lesions (17.4%). Pneumothorax occurred in 27.7% of patients, requiring drainage in 4.3%. Minor alveolar hemorrhage was observed in 16.3%, and one patient (0.5%) experienced a fatal air embolism. Complication rates were significantly associated with greater lesion depth (p = 0.0000632) and smaller lesion size (p = 0.001704), while emphysema showed no significant correlation (p = 0.3928).Conclusion: Image-guided TTNB using a coaxial 17 G/18 G technique demonstrates high diagnostic accuracy and an acceptable safety profile. Lesion depth and size are key predictors of procedural complications. Careful pre-procedural planning and experienced operator technique are critical to optimizing outcomes and minimizing risks.