An average of 1 in 7 lung puncture biopsies results in a pneumothorax, according to a study published online Aug. 1 in the Annals of Internal Medicine. Principal investigator Renda Soylemez Wiener, MD, of Boston University School of Medicine, noted that approximately 25 percent of chest CT scans reveal pulmonary nodules, and there is growing concern about whether nodules should be biopsied. To determine the risk of complications from transthoracic needle biopsy, the researchers analyzed data from California, Florida, Michigan and New York in 2006. The results showed that bleeding occurred in only 1% of 15,865 CT-guided lung nodule biopsies, but 17.8% required blood transfusion. The overall incidence of pneumothorax was 15%, and 6.6% required chest intubation. Respiratory failure was more common in patients with bleeding (4.3%) and in patients with pneumothorax requiring chest intubation (1.4%) than in patients without complications (0.6%). the risk of complications from lung puncture biopsy was highest in patients aged 60 to 69 years, smokers, and patients with chronic obstructive pulmonary disease (COPD). The investigators concluded that, based on these data, it is speculated that thousands of patients in the United States may experience complications after CT-guided lung puncture biopsy each year. Although the study failed to determine the long-term risk-benefit profile of lung puncture biopsy, it at least suggests that the short-term risk of complications is not negligible. Lung puncture biopsy is likely to be redundant in patients who are at low tumor risk, too frail to receive anticancer therapy, or at high tumor risk who should undergo direct surgery, and should be carefully considered by clinicians.