Effectiveness and Safety of Percutaneous Image-Guided Lung Biopsies: Analysis of 27559 Procedures from the German Society for Interventional Radiology and Minimally Invasive Therapy Registry.

Title: Effectiveness and Safety of Percutaneous Image-Guided Lung Biopsies: Analysis of 27,559 Procedures from the DeGIR Registry (2018–2024)

Summary for clinical practice:

• Design & setting: Large multicenter registry analysis from 212 centers in Germany, covering 27,559 percutaneous image-guided lung biopsies performed between 2018 and 2024.

• Technique:
  • Guidance: CT used in 99.4% of cases.
  • Setting: 95.9% performed in the inpatient setting.
  • Anesthesia: Local anesthesia in 97.5% of procedures.

• Performance:
  • Technical success (verified needle placement): 97.7%.
  • Diagnostic yield (adequate histology obtained): 94.3%.
  • Inpatient vs outpatient:
    • Technical success: slightly higher in inpatients (97.8% vs 96.8%, p = 0.032).
    • Diagnostic yield: similar (94.3% vs 92.9%, p = 0.063).

• Safety:
  • Overall complication rate: 19.4%.
  • Major complications (per SIR criteria): 4.9%.
  • Mortality: 0.06%.
  • Coagulation disorders were associated with increased complication risk.

• Clinical implications:
  • Image-guided lung biopsy provides high technical success and diagnostic yield on a national scale, supporting its central role in working up pulmonary nodules, especially as screening expands.
  • The nearly 20% overall and 5% major complication rates underscore the need for:
    • Careful patient selection (particularly evaluating bleeding risk and comorbidities).
    • Individualized risk stratification.
    • Thoughtful decisions on inpatient vs outpatient setting for higher-risk patients.