Procedural efficiency, diagnostic yield, and safety of a novel positioning grid combined with a non-coplanar puncture-angle guide for CT-guided percutaneous transthoracic lung biopsy: a retrospective contemporaneous-control study

Background: Computed tomography (CT)-guided percutaneous transthoracic lung biopsy is an important method for obtaining pathological diagnoses of pulmonary lesions. However, conventional manual localization and needle advancement are operator dependent, and technically difficult lesions may require repeated angle adjustments and CT acquisitions. The aim of this study was to evaluate the procedural efficiency, diagnostic performance, and safety of a novel positioning grid combined with a non-coplanar puncture-angle guide.

Methods: This single-center, retrospective, nonrandomized contemporaneous-control study included 287 patients who underwent CT-guided percutaneous transthoracic lung biopsy between August 2023 and November 2024. The device group comprised 146 patients treated using the novel positioning grid and angle guide, whereas 141 controls underwent biopsy using a conventional positioning grid without the angle guide. Procedure time, number of CT acquisitions, diagnostic yield, and complications were compared. Multivariable binary logistic regression was used to identify factors associated with pneumothorax.

Results: Procedure time was shorter in the device group than in the control group (7.47±2.69 vs. 24.87±7.70 min, P<0.001), and the number of CT acquisitions was lower (4.63±1.08 vs. 6.05±1.99, P<0.001). Diagnostic yield was 98.63% versus 94.33% (P=0.057). Pneumothorax and hemoptysis were less frequent in the device group (7.53% vs. 26.95% and 1.37% vs. 16.31%, respectively; both P<0.001), whereas perineedle-tract hemorrhage was similar (36.99% vs. 33.33%, P=0.517). In multivariable analysis, device-group membership was independently associated with lower odds of pneumothorax [adjusted odds ratio (aOR)=0.19, 95% confidence interval (CI): 0.09–0.40; P<0.001], whereas emphysema or pulmonary bullae were associated with higher odds (aOR=2.41, 95% CI: 1.14–5.09; P=0.022).

Conclusions: Use of the novel positioning grid combined with a non-coplanar puncture-angle guide was associated with shorter procedure time, fewer CT acquisitions, and lower rates of pneumothorax and hemoptysis while maintaining a high diagnostic yield. Prospective multi-operator studies are warranted because the present study was nonrandomized and the groups were treated by different operators.