# Pulmonary Hemorrhage and Pneumothorax Risk During CT-Guided Lung Biopsy for Suspected Lung Cancer

## TL;DR

This study found that limited bleeding during lung biopsies may reduce the risk of lung collapse, especially for deeper lung lesions.

## Contribution

The study reveals a novel inverse relationship between pulmonary hemorrhage and pneumothorax risk during CT-guided lung biopsies.

## Key findings

- Pneumothorax occurred less frequently in patients with pulmonary hemorrhage.
- Lesion depth showed a borderline association with pneumothorax risk, which was potentially attenuated by hemorrhage.

## Abstract

CT-guided lung biopsy is widely used to diagnose suspected lung cancer and to guide treatment decisions such as surgery, radiotherapy, and immunotherapy. Pneumothorax, a collapse of the lung caused by air leakage, is the most common complication of this procedure. Pulmonary hemorrhage, which appears as localized bleeding around the biopsy site, is usually considered an adverse event. In this retrospective study of 118 patients undergoing CT-guided lung biopsy for suspected or confirmed lung cancer, we found that pneumothorax occurred less frequently in patients who developed pulmonary hemorrhage. Our results suggest that limited hemorrhage may partially seal the biopsy tract and reduce air leakage, especially in deeper lung lesions. Understanding this interaction may help improve biopsy safety, reduce procedure-related delays, and support timely initiation of cancer treatments.

Objectives: The aim of this study was to evaluate the association between pulmonary hemorrhage and PTX following CT-guided lung biopsy for suspected or confirmed lung malignancy and to assess whether lesion depth modifies this relationship. Methods: This retrospective single-center study included 118 consecutive patients undergoing CT-guided lung biopsy for oncologic indications between 2020 and 2025 (66 men, 52 women; median age 69 years). Immediate post-biopsy CT was assessed for PTX and focal pulmonary hemorrhage. Multivariable logistic regression identified predictors of PTX, including pulmonary hemorrhage, lesion size and depth, chronic obstructive pulmonary disease, patient positioning, age, and sex. An interaction analysis evaluated effect modification by lesion depth. Results: PTX occurred in 22.0% of biopsies, and pulmonary hemorrhage in 29.7%. PTX was significantly less frequent in patients with pulmonary hemorrhage (p = 0.021). Lesion depth showed a borderline association with PTX risk (OR 1.02 per mm; p = 0.060). Pulmonary hemorrhage demonstrated a nonsignificant protective trend (OR 0.33; p = 0.135). The hemorrhage–depth interaction approached significance (p = 0.065), suggesting attenuation of depth-related PTX risk. Model discrimination was moderate (AUC = 0.709). Conclusions: In patients undergoing CT-guided biopsy for lung cancer evaluation, pulmonary hemorrhage may mitigate PTX risk, particularly for deeper lesions.