{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T05:25:44Z","timestamp":1777440344685,"version":"3.51.4"},"reference-count":30,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T00:00:00Z","timestamp":1777334400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Purpose: In this study, our aim is to assess the efficacy of saline-assisted needle withdrawal in minimizing pneumothorax and bleeding complications during CT-guided lung biopsies. Methods: In this retrospective study, 400 patients who underwent CT-guided lung biopsy were divided into two groups: 200 patients underwent conventional needle withdrawal (control group), and the other 200 patients underwent saline-assisted needle withdrawal (NaCl group). Needle angle, patient positioning, demographic data, and other procedural variables were collected. The primary outcome was the incidence of pneumothorax; secondary outcomes included bleeding rates and the impact of procedural factors on complication risk. Statistical analyses included Chi-square tests, logistic regression, and multinomial modeling. Results: The NaCl group demonstrated a significantly lower incidence of clinically significant pneumothorax (13.5%) compared to the control group (22.0%) (p = 0.007), while bleeding complications occurred in 26.5% of patients in the former versus 45.0% in the latter (p &lt; 0.001). Multivariate analysis suggested a non-significant trend toward a higher pneumothorax risk with shallow needle angles (&lt;60\u00b0; p = 0.502). Saline injection was especially advantageous in patients with underlying lung disease, reducing pneumothorax severity even when overall incidence rates were similar. No adverse events were attributed to the use of saline. Conclusions: Saline-assisted tract sealing is a safe and cost-effective technique that significantly reduces the risk of clinically significant pneumothorax and bleeding in CT-guided lung biopsies. Due to its simplicity and favorable safety profile, this approach holds considerable promise for widespread clinical implementation.<\/jats:p>","DOI":"10.3390\/diagnostics16091322","type":"journal-article","created":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T11:33:37Z","timestamp":1777376017000},"page":"1322","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Reducing Lung Biopsy Complications with Saline Injection: Evidence from a CT-Guided Cohort Study"],"prefix":"10.3390","volume":"16","author":[{"given":"Mohammed","family":"Khalaf","sequence":"first","affiliation":[{"name":"Department of Neuroradiology, University Medical Center Mainz, Johannes Gutenberg University, 55131 Mainz, Germany"},{"name":"Department of Radiology, Catholic Clinic Koblenz-Montabaur, 56073 Koblenz, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yaroslava","family":"Von Rymon Lipinski","sequence":"additional","affiliation":[{"name":"Department of Radiology, Catholic Clinic Koblenz-Montabaur, 56073 Koblenz, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sascha","family":"Herber","sequence":"additional","affiliation":[{"name":"Department of Radiology, Catholic Clinic Koblenz-Montabaur, 56073 Koblenz, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,28]]},"reference":[{"key":"ref_1","first-page":"229","article-title":"Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"74","author":"Bray","year":"2024","journal-title":"CA Cancer J. Clin."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Amicizia, D., Piazza, M.F., Marchini, F., Astengo, M., Grammatico, F., Battaglini, A., Schenone, I., Sticchi, C., Lavieri, R., and Di Silverio, B. (2023). Systematic Review of Lung Cancer Screening: Advancements and Strategies for Implementation. Healthcare, 11.","DOI":"10.3390\/healthcare11142085"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Borelli, C., Vergara, D., Simeone, A., Pazienza, L., Castorani, G., Graziano, P., Di Micco, C., Quarato, C.M.I., and Sperandeo, M. (2022). CT-Guided Transthoracic Biopsy of Pulmonary Lesions: Diagnostic versus Nondiagnostic Results. Diagnostics, 12.","DOI":"10.3390\/diagnostics12020359"},{"key":"ref_4","first-page":"50","article-title":"Screening for lung cancer: 2023 guideline update from the American Cancer Society","volume":"74","author":"Wolf","year":"2024","journal-title":"CA Cancer J. Clin."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"497","DOI":"10.6004\/jnccn.2022.0025","article-title":"Non-Small Cell Lung Cancer, Version 3.2022, NCCN Clinical Practice Guidelines in Oncology","volume":"20","author":"Ettinger","year":"2022","journal-title":"J. Natl. Compr. Cancer Netw."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"965","DOI":"10.1016\/j.diii.2016.06.016","article-title":"Image-guided biopsy in primary lung cancer: Why, when and how","volume":"97","year":"2016","journal-title":"Diagn. Interv. Imaging"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Saggiante, L., Biondetti, P., Lanza, C., Carriero, S., Ascenti, V., Piacentino, F., Shehab, A., Ierardi, A.M., Venturini, M., and Carrafiello, G. (2024). Computed-Tomography-Guided Lung Biopsy: A Practice-Oriented Document on Techniques and Principles and a Review of the Literature. Diagnostics, 14.","DOI":"10.3390\/diagnostics14111089"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1007\/s00330-016-4357-8","article-title":"Complication rates of CT-guided transthoracic lung biopsy: Meta-analysis","volume":"27","author":"Heerink","year":"2017","journal-title":"Eur. Radiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1097\/RTI.0000000000000215","article-title":"Nonclotted Blood Patch Technique Reduces Pneumothorax and Chest Tube Placement Rates After Percutaneous Lung Biopsies","volume":"31","author":"Clayton","year":"2016","journal-title":"J. Thorac. Imaging"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"800","DOI":"10.1111\/1754-9485.13090","article-title":"Tract sealing with normal saline after percutaneous transthoracic lung biopsies\u2014Promising but better evidence required","volume":"64","author":"Chan","year":"2020","journal-title":"J. Med. Imaging Radiat. Oncol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1845","DOI":"10.1007\/s00330-015-3601-y","article-title":"Rapid needle-out patient-rollover approach after cone beam CT-guided lung biopsy: Effect on pneumothorax rate in 1,191 consecutive patients","volume":"25","author":"Park","year":"2015","journal-title":"Eur. Radiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1016\/j.ejrad.2012.09.013","article-title":"Breath-hold after forced expiration before removal of the biopsy needle decreased the rate of pneumothorax in CT-guided transthoracic lung biopsy","volume":"82","author":"Min","year":"2013","journal-title":"Eur. J. Radiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1093\/bjr\/tqae228","article-title":"Efficacy of needle tract embolization using gelfoam in reducing incidence of Pneumothorax in CT-guided transthoracic Lung Biopsies: A Systematic Review and Meta-analysis","volume":"98","author":"Singh","year":"2024","journal-title":"Br. J. Radiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"678","DOI":"10.1111\/1754-9485.13256","article-title":"Gelfoam slurry tract occlusion after computed tomography-guided percutaneous lung biopsy: Does it prevent major pneumothorax?","volume":"65","author":"Sum","year":"2021","journal-title":"J. Med. Imaging Radiat. Oncol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"783","DOI":"10.2214\/AJR.10.6324","article-title":"CT-guided lung biopsies: Pleural blood patching reduces the rate of chest tube placement for postbiopsy pneumothorax","volume":"197","author":"Wagner","year":"2011","journal-title":"Am. J. Roentgenol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1111\/1754-9485.13002","article-title":"Tract sealing with normal saline after percutaneous transthoracic lung biopsies","volume":"64","author":"Babu","year":"2020","journal-title":"J. Med. Imaging Radiat. Oncol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"604","DOI":"10.1007\/s00270-023-03648-y","article-title":"Pneumothorax Incidence with Normal Saline Instillation for Sealing the Needle Track After Computed Tomography-Guided Percutaneous Lung Biopsy","volume":"47","author":"Bourgeais","year":"2024","journal-title":"Cardiovasc. Interv. Radiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1016\/j.carj.2018.08.002","article-title":"Injection of Saline Into the Biopsy Tract and Rapid Patient Rollover Decreases Pneumothorax Size Following Computed Tomography-Guided Transthoracic Needle Biopsy","volume":"69","author":"Khorochkov","year":"2018","journal-title":"Can. Assoc. Radiol. J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1192","DOI":"10.1016\/j.crad.2015.06.081","article-title":"Usefulness of normal saline for sealing the needle track after CT-guided lung biopsy","volume":"70","author":"Li","year":"2015","journal-title":"Clin. Radiol."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Roman, A., Brozba, A., Necula, A., Muntean, D.D., Kubelac, P., Fekete, Z., Tomuleasa, C., Csutak, C., Feier, D., and Pintican, R. (2023). Usefulness of Saline Sealing in Preventing Pneumothorax after CT-Guided Biopsies of the Lung. Diagnostics, 13.","DOI":"10.3390\/diagnostics13233546"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Satomura, H., Higashihara, H., Kimura, Y., Nakamura, M., Tanaka, K., Ono, Y., Kuriu, A., and Tomiyama, N. (2024). Normal saline injection and rapid rollover; preventive effect on incidence of pneumothorax after CT-guided lung biopsy: A retrospective cohort study. BMC Pulm. Med., 24.","DOI":"10.1186\/s12890-024-03315-z"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Constantinescu, A., Stoicescu, E.R., Iacob, R., Chira, C.A., Cocolea, D.M., Nicola, A.C., Mladin, R., Oancea, C., and Manolescu, D. (2024). CT-Guided Transthoracic Core-Needle Biopsy of Pulmonary Nodules: Current Practices, Efficacy, and Safety Considerations. J. Clin. Med., 13.","DOI":"10.3390\/jcm13237330"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"3660","DOI":"10.1007\/s00330-020-06771-3","article-title":"Deep learning algorithm for surveillance of pneumothorax after lung biopsy: A multicenter diagnostic cohort study","volume":"30","author":"Hwang","year":"2020","journal-title":"Eur. Radiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2022","DOI":"10.1007\/s00330-020-07372-w","article-title":"Incidence, risk factors, and prognostic indicators of symptomatic air embolism after percutaneous transthoracic lung biopsy: A systematic review and pooled analysis","volume":"31","author":"Lee","year":"2021","journal-title":"Eur. Radiol."},{"key":"ref_25","first-page":"S372","article-title":"Pneumothorax: From definition to diagnosis and treatment","volume":"6","author":"Zarogoulidis","year":"2014","journal-title":"J. Thorac. Dis."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"969","DOI":"10.1016\/j.jvir.2010.01.011","article-title":"Quality improvement guidelines for percutaneous needle biopsy","volume":"21","author":"Gupta","year":"2010","journal-title":"J. Vasc. Interv. Radiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1007\/s00270-016-1489-9","article-title":"Efficacy of a Self-expanding Tract Sealant Device in the Reduction of Pneumothorax and Chest Tube Placement Rates After Percutaneous Lung Biopsy: A Matched Controlled Study Using Propensity Score Analysis","volume":"40","author":"Ahrar","year":"2017","journal-title":"Cardiovasc. Interv. Radiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"170020","DOI":"10.1183\/16000617.0020-2017","article-title":"Management of anticoagulant and antiplatelet therapy in patients undergoing interventional pulmonary procedures","volume":"26","author":"Pathak","year":"2017","journal-title":"Eur. Respir. Rev. Off. J. Eur. Respir. Soc."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Tsai, S.C.-S., Wu, T.-C., and Lin, F.C.-F. (2024). Optimizing Precision: A Trajectory Tract Reference Approach to Minimize Complications in CT-Guided Transthoracic Core Biopsy. Diagnostics, 14.","DOI":"10.3390\/diagnostics14080796"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"748","DOI":"10.1378\/chest.126.3.748","article-title":"Risk factors of pneumothorax and bleeding: Multivariate analysis of 660 CT-guided coaxial cutting needle lung biopsies","volume":"126","author":"Yeow","year":"2004","journal-title":"Chest"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/9\/1322\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T12:11:12Z","timestamp":1777378272000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/9\/1322"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,28]]},"references-count":30,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["diagnostics16091322"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16091322","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,28]]}}}