Background: This study aims to correlate nodule, patient, and technical risk factors less commonly investigated in the literature with pneumothorax development during computed tomography-guided core needle lung nodule biopsy. Patients and Methods: Retrospective data on 671 computed tomography-guided percutaneous core needle lung biopsies from 671 patients at a tertiary care center between March 2014 and August 2016. Univariate and multivariable logistic regression analyses were used to identify pneumothorax risk factors. Results: The overall incidence of pneumothorax was 26.7 (n = 179). Risk factors identified on univariate analysis include anterior odds ratio (OR) = 1.98; P< 0.001 and lateral (OR = 2.17; P=0.002) pleural surface puncture relative to posterior puncture, traversing more than one pleural surface with the biopsy needle (OR = 2.35; P = 0.06), patient positioning in supine (OR = 2.01; P< 0.001) and decubitus nodule side up (OR = 2.54; P = 0.001) orientation relative to decubitus nodule side down positioning, and presence of emphysema in the path of the biopsy needle (OR = 3.32; P < 0.001). In the multivariable analysis, the presence of emphysematous parenchyma in the path of the biopsy needle was correlated most strongly with increased odds of pneumothorax development (OR = 3.03; P = 0.0004). Increased body mass index (OR = 0.95; P=0.001) and larger nodule width (cm; OR = 0.74; P = 0.02) were protective factors most strongly correlated with decreased odds of pneumothorax development. Conclusion: Emphysema in the needle biopsy path is most strongly associated with pneumothorax development. Increases in patient body mass index and width of the target lung nodule are most strongly associated with decreased odds of pneumothorax.
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