Effectiveness of normal saline instillation in sealing the biopsy tract to reduce complications of CT-guided transthoracic lung biopsy: A hospital-based interventional study

Background: Computed tomography (CT)-guided transthoracic lung biopsy is a crucial diagnostic procedure for pulmonary lesions, but it is associated with complications, most notably pneumothorax. This study aimed to evaluate the effectiveness of sealing the biopsy tract with sterile normal saline to reduce iatrogenic complications.

Methods: This longitudinal, hospital-based interventional study included 84 patients with lung masses (≥3 cm) undergoing CT-guided core biopsy. Patients were alternately assigned to two groups: Group A (n=42), where the biopsy tract was sealed with 4 mL of sterile 0.9% normal saline post-procedure, and Group B (n=42), where no sealant was used (control). The primary outcome was the incidence of pneumothorax. Secondary outcomes included rates of chest tube insertion and other complications.

Results: The overall incidence of pneumothorax was 22.61% (19/84). The incidence of pneumothorax was significantly lower in the saline sealing group (Group A) compared to the control group (Group B) (6% vs. 16%; p=0.0352). Chest tube insertion was required in 1 patient (2.4%) in Group A and 3 patients (7.1%) in Group B, though this difference was not statistically significant. The intervention also significantly reduced pneumothorax incidence in high-risk subgroups, including patients with smaller lesions (3-5 cm), emphysema, and a history of smoking. There was no significant difference in the incidence of post-procedural haemoptysis between the groups.

Conclusion: Sealing the biopsy tract with normal saline is a safe, inexpensive, and effective technique that significantly reduces the incidence of iatrogenic pneumothorax following CT-guided transthoracic lung biopsy, particularly in high-risk patients. This simple manoeuvre should be considered for routine clinical practice.