SALINE tract sealing may reduce the risk of pneumothorax and the need for chest tube placement following CT-guided lung biopsy, according to an updated meta-analysis of seven studies involving 1,455 patients.
CT-guided percutaneous transthoracic lung biopsy is widely used to obtain tissue samples from lung lesions. While the procedure is highly valuable for diagnosis, it carries the risk of pneumothorax, a condition where air collects in the space between the lung and chest wall and can cause partial or complete lung collapse. In some cases, chest tube insertion is required to manage the complication.
Lower Complication Rates Seen with Saline Tract Sealing
680 patients (46.7%) received normal saline tract instillation after CT-guided lung biopsy. These patients’ outcomes were then compared to those receiving standard care without saline tract sealing.
The pooled analysis showed that saline tract sealing was linked to significantly lower rates of pneumothorax (p = 0.002). Patients who received saline had a risk ratio of 0.46 or pneumothorax compared with usual care, indicating a substantially lower likelihood of developing the complication.
The intervention was also associated with fewer chest tube placements. The risk ratio for chest tube insertion was 0.24, suggesting that patients undergoing saline tract sealing were less likely to require further intervention following biopsy.
Building Evidence for a Simple Technique
Several needle-tract sealing approaches have been proposed to reduce the risk of pneumothorax after biopsy, but evidence supporting saline as a sealing material has remained limited. The updated findings add data from a larger patient population and strengthen the evidence base for this relatively straightforward technique.
Interpreting the Findings in Context
The results suggest that normal saline may be an effective needle-tract sealing material during CT-guided lung biopsy and highlight its potential role in improving procedural safety. As the analysis included a total of 1,455 patients from seven studies, it is one of the more comprehensive assessments of saline tract sealing.
However, the study was a meta-analysis of previously conducted studies rather than a single prospective trial. The investigators also reported moderate heterogeneity for the pneumothorax outcome, with an I² value of 50%. This means there was a moderate degree of variation in the pneumothorax results across the seven included studies that could not be explained by chance alone. Differences in patient populations, biopsy techniques, operator experience and study design may have contributed to this variability.
As a result, while the overall findings suggest a benefit associated with saline tract sealing, the size of that benefit may not have been identical in every study setting.
Reference
Kayaoglu AT et al. Efficacy of saline tract sealing after CT-guided lung biopsy: a systematic review and meta-analysis. Clin Radiol. 2026;DOI:10.1016/j.crad.2026.107401.
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