Assessment of diagnostic performance and complication rate in percutaneous lung biopsy based on target nodule size

Percutaneous lung biopsies are a common radiologic procedure, although they are not without risk. As imaging techniques continue to increase in sophistication, referring providers may request lung biopsies on smaller and smaller targets. Our purpose is to better understand when we should expect lung biopsies to yield diagnostic results of lung nodules of varying sizes and how size impacts the complication rate of the procedure.

We retrospectively reviewed all outpatient lung biopsies performed at our institution between January 1, 2019, and June 30, 2020. For all procedures, target nodule size, location, diagnostic performance, and complication rates were recorded.

We found that diagnostic yield increased with increasing nodule size, with ROC analysis indicating that the best threshold size to predict a diagnostic sample is 1.4 cm. Pneumothorax rate significantly increased with decreasing target size, but there was no significant association between target size and the need for either chest tube placement or hospital admission.

The smaller a lung nodule is, the harder it is to obtain a diagnostic sample, and the more likely it is to develop a post-biopsy pneumothorax. However, smaller target size is not associated with an increased risk of chest tube placement or hospital admission.