The Association Between Core Number and Complications in Ultrasound-Guided Percutaneous Lung Core Needle Biopsy: A Retrospective Study

The Association Between Core Number and Complications in Ultrasound-Guided Percutaneous Lung Core Needle Biopsy: A Retrospective Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Association Between Core Number and Complications in Ultrasound-Guided Percutaneous Lung Core Needle Biopsy: A Retrospective Study Mengjun Shen, Hongwei Chen, Jixin Shu, Yang Cong, Yi Zhang, Huiming Zhu, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6435769/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 12 You are reading this latest preprint version Abstract Background With advances in lung cancer management, there is a growing need for larger tissue samples to enable tumor genomic analysis and characterization.This study aims to determine whether the core number obtained during Ultrasound-guided percutaneous lung core needle biopsy(US-PLCNB) is associated with post-procedural complications. Methods This retrospective study enrolled consecutive patients who underwent US-PLCNB for primary lung cancer at Shanghai Pulmonary Hospital between July 2019 and September 2021. Patient data were extracted from medical records, including demographics, lesion size, and core number. Post-procedural complications, including hemoptysis, pneumothorax, intolerable pain, pleural reaction, hemothorax, and delayed hemopneumothorax, were documented. Multivariate logistic regression models were used to evaluate whether the core number was an independent predictor of complications following US-PLCNB. Results A total of 1,151 patients (mean age, 64.47 ± 10.58 [SD] years; 278 [24.15%] females and 873 [75.85%] males) were included. The median lesion size was 58 mm (IQR, 41–77 mm). Among the 1,151 patients, 417 (36.23%) were diagnosed with lung adenocarcinoma, and 322 (27.98%) with lung squamous cell carcinoma. Post-procedural complications occurred in 41 patients (3.56%), including: hemoptysis (26 cases, 2.26%), pneumothorax (7 cases, 0.61%), intolerable pain (3 cases, 0.26%), pleural reaction (2 cases, 0.17%), hemothorax (2 cases, 0.17%), and delayed hemopneumothorax (1 case, 0.09%). The median number of biopsy cores obtained was 3 (range: 1–7). Multivariate analysis revealed no evidence of an association between the number of cores and complications: hemoptysis (OR = 0.846, P = 0.524), pneumothorax (OR = 1.378, P = 0.544), intolerable pain (OR = 0.502, P = 0.381), pleural reaction (OR = 1.177, P = 0.866), hemothorax (OR = 1.116, P = 0.906), delayed hemopneumothorax (OR = 1.182, P = 0.903). Conclusion In patients undergoing US-PLCNB for primary lung cancer, no evidence was found of an association between the core number biopsy samples obtained and post-procedural complications. Ultrasound-guided percutaneous lung core needle biopsy(US-PLCNB) Core number Complications Background While pathologists can diagnose pulmonary malignancies through morphological evaluation of minimal tissue samples [ 1 ], the rapid advancement of immunotherapy and precision therapies based on genomic profiling has precipitated a paradigm shift in tissue requirements. The exponential growth in biomarker targets requiring assessment—from programmed cell death ligand 1 (PD-L1) expression to driver mutations—has driven an unprecedented demand for larger biopsy volumes [ 2 ]. This paradigm evolution mandates the procurement of multiple core specimens to satisfy both diagnostic verification and comprehensive molecular profiling needs [ 3 ], thereby raising critical clinical questions regarding the safety implications of expanded sampling protocols. Although CT-guided lung biopsy is widely used for peripheral pulmonary lesions, ultrasound-guided is gaining increasing popularity [ 4 ]. Ultrasound-guided percutaneous lung core needle biopsy(US-PLCNB) can be performed when the lesion is in contact with the pleura or when there is consolidation between the lesion and the pleura. Compared to CT-guided, US-PLCNB is a radiation-free, real-time, and cost-effective bedside procedure that allows operators to avoid blood vessels or necrotic areas during needle insertion using Doppler ultrasound or contrast-enhanced ultrasound [ 5 , 6 ]. Although US-PLCNB is highly safe and minimally invasive, as an invasive diagnostic procedure, it still carries risks of needle-related complications during radiologist-performed punctures, such as hemoptysis, pneumothorax, and in severe cases, even fatal outcomes [ 7 – 9 ]. In a meta-analysis of 12 studies [ 10 ] involving 3,830 patients who underwent ultrasound-guided percutaneous lung core needle biopsies, the most common complications were self-limited hemoptysis (2.3%) and asymptomatic pneumothorax (1.2%). Only 6 cases of pneumothorax requiring chest tube drainage and 1 case of severe hemorrhage were reported. Factors associated with an increased risk of post-biopsy hemoptysis, pneumothorax, or perilesional bleeding included smaller lesion size, shorter pleural contact length, bronchus sign, and perilesional vessels [ 11 – 14 ]. Based on these findings, it is reasonable to hypothesize that increasing the number of core needle passes through the pleura and lung parenchyma may elevate complication rates. However, Charissa et al. [ 15 ], in a study of 827 patients undergoing CT-guided lung biopsies, similarly found no evidence of an association between the number of core biopsy samples obtained and post-procedural complications. Nevertheless, research evaluating the impact of the number of needle passes in US-PLCNB remains extremely limited. Therefore, this study aims to determine whether the core number obtained via US-PLCNB is associated with post-procedural complications. Materials and Methods This was a single centre retrospective study of US-PLCNB in patients. Informed consent was obtained from each patient prior to undergoing US-PLCNB. The study was conducted in accordance with the Declaration of Helsinki. Institutional review board approval was obtained. Patients and Data Collection Consecutive patients aged over 18 years who underwent ultrasound-guided percutaneous lung biopsy (US-PTNB) for suspected primary lung cancer at Shanghai Pulmonary Hospital between July 2019 and September 2021 were included. A retrospective review was conducted on all US-PTNB procedures, intraoperative ultrasound images, patient and procedural data recorded in the electronic medical records (eHis), and pathological reports of biopsy specimens. Data collection was performed by six trained researchers (MS, HC, JS, YC, YZ, HZ) and included: (1) gender, (2) age, (3) lesion size (longest diameter: ≤3 cm, > 3 cm), (4) core number. Post-procedural complications were recorded, including type (hemoptysis, pneumothorax, pleural reaction, intolerable pain, hemothorax, delayed hemopneumothorax). Patients with non-pulmonary metastatic malignancies, benign lesions, or incomplete medical records were excluded. All cases were pathologically confirmed (via biopsy or surgery). Exclusion criteria for US-PLCNB were: Patients with severe psychiatric disorders unable to cooperate with the procedure; Patients or family members refusing the procedure; Patients with uncorrectable coagulopathy (INR > 1.5 or platelet count < 50 ×10⁹/L); Patients taking anticoagulants or antiplatelet agents within one week prior to biopsy; Patients with severe respiratory or circulatory failure. Patients presenting with any of the above contraindications were excluded from undergoing biopsy. Procedure Examiners utilized the LOGIQ E9 ultrasound system (GE Healthcare) equipped with a 1–6 MHz convex probe to independently conduct ultrasound examinations. General considerations for needle entry included avoiding traversal of interlobar fissures, selecting the shortest path to the lesion, and circumventing blood vessels and bronchi along the needle trajectory, ideally positioning the lesion in a dependent or accessible location. After skin disinfection, 2% lidocaine was administered subcutaneously using a 22-gauge needle. A biopsy device (Bard Mission; BD Biosciences) with a 12 mm or 22 mm throw and 18G or 16G gauge (adjusted based on lesion size) was deployed. Needle lengths ranged from 10 cm to 16 cm, tailored to the patient’s body habitus and lesion depth/location. In select cases, a Bard coaxial introducer needle was utilized as a guiding sheath, depending on the biopsy device configuration. Under real-time ultrasound guidance, the biopsy needle was advanced toward the target subpleural pulmonary lesions. Radiologists employed a freehand technique for needle manipulation. If gross inspection suggested inadequate or non-diagnostic samples, additional cores were obtained. Post-procedural protocol: Patients were instructed to maintain strict bed rest for 30 minutes with ice pack application to the puncture site for hemostasis. A 30-minute follow-up ultrasound was performed to evaluate for hemorrhage or pneumothorax. If no complications were identified: hospitalized patients returned to their wards; Outpatients were discharged after 2 hours of observation, with instructions to seek emergency care immediately for acute pain or hemodynamic instability (e.g., hypotension, tachycardia). Statistical Analysis Descriptive statistics were used. Quantitative data are presented as mean ± standard deviation (SD) or median and interquartile ranges (IQRs). Categorical data are expressed as counts and percentages. A linear-by-linear association test was employed to evaluate correlations between the number of samples obtained and binary variables (gender, premature procedure termination, diagnostic biopsy, hemoptysis, pneumothorax, intolerable pain, pleural reaction, hemothorax, delayed hemopneumothorax). Kendall’s tau-b correlation coefficient was used to assess the relationship between the number of samples and continuous variables (age, lesion size). Multivariate logistic regression models, adjusted for clinical and procedural characteristics, were applied to determine whether the number of cores was independently associated with the incidence of complications (hemoptysis, pneumothorax, pleural reaction, intolerable pain, hemothorax, delayed hemopneumothorax). A P value < 0.05 was considered statistically significant. All analyses were performed using IBM SPSS Statistics, Version 27.0. Result Patient Characteristics and Complication Rates The initial study cohort included 1,544 patients who underwent ultrasound-guided biopsies during the study period. 393 patients were excluded (Fig. 3): 368 patients (23.83% ) had pulmonary metastatic lesions, 14 patients (0.91%) had benign lesions, 11 patients (0.71%) had incomplete medical records. The final analysis included 1,151/1,544 patients (74.55%) (mean age, 64.47 ± 10.58 years [SD]; 278 [24.15%] females; 873 [75.85%] males) with pulmonary lesions suspected of primary lung cancer who underwent ultrasound-guided lung biopsies. The overall diagnostic accuracy rate was 97.22% (1,119/1,151). Among the 1,151 diagnostic biopsies, 417 (36.23%) were pathologically confirmed as lung adenocarcinoma, and 322 (27.98%) as lung squamous cell carcinoma (Table 1 ). Overall complications occurred in 41/1,151 cases (3.56%), with hemoptysis in 26 of 1,151(2.26%), pneumothorax in 7 of 1,151 (0.61%), intolerable pain in 3 of 1,151 (0.26%), pleural reaction in 2 of 1,151 (0.17%), hemothorax in 2 of 1,151 (0.17%), delayed hemopneumothorax in 1 of 1,151 (0.09%) (Table 1 ). No air embolism or mortality occurred in the study. The median number of core biopsy passes was 3 (range: 1–7). Table 1 Patient Characteristics, Puncture Characteristics, and Postprocedural Complications Characteristic Value Mean age (y) * 64.47 ± 10.58(20–96) Total no. of patients 1151 Sex Female 278(24.15) Male 873(75.85) Lesion size (mm) † 58(41 ~ 77) Diagnostic success 1119(97.22) Histopathologic result Adenocarcinoma 417(36.23) Squamous cell carcinoma 322(27.98) Non-small cell lung cancer 154(13.38) Lung cancer (unclassified) 78(6.78) Small cell carcinoma 72(6.26) Lung cancer (poorly differentiated) 34(2.95) Other § 74(6.43) Postprocedural complications 41(3.56) Hemoptysis 26(2.26) Pneumothorax 7(0.61) Unbearable pain 3(0.26) Pleural reaction 2(0.17) Hemothorax 2(0.17) Delayed hemopneumothorax 1(0.09) Note.—Unless otherwise indicated, data are numbers of patients. Data in parentheses are percentages. * Value is mean ± SD; value in parentheses is the range. † Data are medians; data in parentheses are IQRs. § Other included neuroendocrine carcinoma, sarcoma, sarcomatoid carcinoma, lymphoma, adenosquamous carcinoma, metastatic carcinoma, etc. In 4 patients, the procedure was terminated prematurely. These patients underwent 2 biopsy passes (range: 1–2 passes). Reasons for early termination included pneumothorax in 2 of 4 (50%), intolerable pain in 1 of 4 (25%), pleural reaction in 1 of 4 (25%). In the univariate analysis, no significant associations were observed between the number of samples obtained and the incidence of hemoptysis (P = 0.429), pneumothorax (P = 0.804), intolerable pain (P = 0.444), pleural reaction (P = 1.000), hemothorax (P = 1.000), or delayed hemopneumothorax (P = 1.000) (Table 2 ). Notably, a higher number of samples was obtained with larger lesion size (P < 0.001); the proportion of male patients increased with the number of samples obtained (P = 0.028); premature procedure termination occurred exclusively in patients undergoing 1–2 biopsy passes (P = 0.001) (Table 2 ). Table 2 Patient characteristics and postoperative complications by the core number of US-PLCNB Variable No. of Samples One (n = 27) Two (n = 221) Three (n = 583) Four or More (n = 320) P Value Age * 63(58 ~ 71) 63(60 ~ 71) 66(60 ~ 71) 65(58 ~ 72) 0.522 Lesion size(mm) * 43(31 ~ 57) 50(37 ~ 74) 58(42 ~ 75) 64(46 ~ 86) <0.001 Male sex 16(59.26) 161(72.85) 445(76.33) 251(78.44) 0.028 Procedure terminated early 1(3.70) 3(1.36) 0 0 0.001 Diagnostic success 25(92.59) 215(97.29) 570(97.77) 309(96.56) 1.000 Hemoptysis 0 7(3.17) 14(2.40) 5(1.56) 0.429 Pneumothorax 0 2(0.90) 2(0.34) 3(0.94) 0.804 Unbearable pain 1(3.70) 0 1(0.17) 1(0.31) 0.444 Pleural reaction 0 1(0.45) 0 1(0.31) 1.000 Hemothorax 0 0 2(0.34) 0 1.000 Delayed hemopneumothorax 0 0 1(0.17) 0 1.000 Note.—Data are numbers of patients; data in parentheses are percentages. US-PLCNB, Ultrasound-guided percutaneous lung core needle biopsy. * Data are medians; data in parentheses are IQRs. Multivariate Analysis of the Association Between Core Number and Complications Multivariate analysis revealed no evidence of an independent association between the number of cores obtained and the incidence of post-procedural complications: hemoptysis (OR = 0.846, P = 0.524), pneumothorax (OR = 1.378, P = 0.544), intolerable pain (OR = 0.502, P = 0.381), pleural reaction (OR = 1.177, P = 0.866), hemothorax (OR = 1.116, P = 0.906), delayed hemopneumothorax (OR = 1.182, P = 0.903) (Table 3 ). Age was significantly associated with intolerable pain (OR = 0.907, P = 0.033) (Table 3 ). Table 3 Multivariate logistic regression analysis of complications of US-PLCNB Characteristic B SE Wals df P Value OR 95% CI for OR 95% CI for OR Lower Upper Hemoptysis Male sex 0.188 0.486 0.150 1 0.698 1.207 0.466 3.129 Age -0.011 0.019 0.353 1 0.553 0.989 0.953 1.026 Lesion size -0.01 0.008 1.522 1 0.217 0.990 0.974 1.006 No. of samples -0.167 0.262 0.405 1 0.524 0.846 0.506 1.415 Constant -2.094 1.501 1.945 1 0.163 0.123 Pneumothorax Male sex -0.357 0.853 0.176 1 0.675 0.700 0.132 3.720 Age 0.042 0.042 0.996 1 0.318 1.043 0.960 1.133 Lesion size -0.019 0.018 1.142 1 0.285 0.981 0.947 1.016 No. of samples 0.321 0.529 0.368 1 0.544 1.378 0.489 3.886 Constant -7.567 3.386 4.994 1 0.025 0.001 Unbearable pain Male sex -0.976 1.298 0.566 1 0.452 0.377 0.030 4.792 Age -0.098 0.046 4.545 1 0.033 0.907 0.829 0.992 Lesion size -0.027 0.027 1.017 1 0.313 0.973 0.923 1.026 No. of samples -0.69 0.787 0.769 1 0.381 0.502 0.107 2.345 Constant 3.59 3.754 0.915 1 0.339 36.226 Pleural reaction Male sex -1.411 1.434 0.968 1 0.325 0.244 0.015 4.055 Age 0.142 0.089 2.528 1 0.112 1.152 0.968 1.372 Lesion size -0.021 0.036 0.353 1 0.552 0.979 0.912 1.051 No. of samples 0.163 0.963 0.029 1 0.866 1.177 0.178 7.77 Constant -14.715 7.362 3.995 1 0.046 0.000 Hemothorax Male sex 15.198 2095.556 0.000 1 0.994 3986264.888 0.000 . Age -0.012 0.073 0.027 1 0.870 0.988 0.856 1.141 Lesion size -0.084 0.050 2.799 1 0.094 0.919 0.833 1.015 No. of samples 0.109 0.924 0.014 1 0.906 1.116 0.182 6.826 Constant -17.218 2095.563 0.000 1 0.993 0.000 Delayed hemopneumothorax Male sex 14.114 2189.357 0.000 1 0.995 1347569.579 0.000 . Age 0.088 0.126 0.491 1 0.484 1.092 0.854 1.397 Lesion size -0.049 0.062 0.641 1 0.423 0.952 0.843 1.074 No. of samples 0.168 1.368 0.015 1 0.903 1.182 0.081 17.272 Constant -25.06 2189.379 0.000 1 0.991 0.000 Note.—The logistic regression models included all relevant patient and biopsy characteristics. US-PLCNB, Ultrasound-guided percutaneous lung core needle biopsy; B, coefficient; CI, confidence interval; df, degree of freedom; OR, odds ratio; SE, standard error; Wald, χ2 value. Discussion Advances in lung cancer treatment now require more tissue samples than before, which may expose patients to additional complications during US-PLCNB. In a retrospective study of 1151 patients undergoing US-guided lung core biopsy for suspected primary lung cancer, no evidence was found of an independent correlation between the number of samples obtained and any postoperative complications: hemoptysis (OR = 0.846, P = 0.524), pneumothorax (OR = 1.378, P = 0.544), intolerable pain (OR = 0.502, P = 0.381), pleural reaction (OR = 1.177, P = 0.866), hemothorax (OR = 1.116, P = 0.906), and delayed hemopneumothorax (OR = 1.182, P = 0.903). Optimizing lung biopsy sample acquisition holds significant clinical value for guiding precision medicine practices, particularly in the era of targeted therapies where adequate tumor tissue volume is essential for high-quality genomic analysis [ 16 , 17 ]. Existing evidence demonstrates that increasing biopsy sample quantity not only enhances the accuracy of tumor heterogeneity assessment—such as providing more comprehensive characterization of PD-L1 spatial heterogeneity [ 18 ]—but also directly impacts molecular testing efficacy. Clinical data reveal that three core-needle biopsies optimize diagnostic sensitivity for malignancy detection [ 19 ], while four or more biopsy cores simultaneously improve both sensitivity and specificity for successful next-generation sequencing [ 20 ]. The novel contribution of this study lies in demonstrating that even when exceeding four biopsy passes, there is no statistically significant increase in complication rates. Consequently, we propose adopting 4–5 core-needle biopsies as a standardized protocol for patients requiring genomic profiling. This approach ensures sufficient tissue yield for molecular diagnostics while maintaining procedural safety. Our findings demonstrate that hemoptysis and pneumothorax were the most common complications of US-guided lung biopsy in our study. The hemoptysis rate in our cohort was 2.26%, and the pneumothorax rate was 0.61%. These values fall within or are slightly lower than the ranges described in the literature (2.3–5.1% for hemoptysis and 1–6% for pneumothorax) [ 10 , 13 , 21 , 22 ]. The lower incidence of hemoptysis at our institution may be attributed to our protocol of performing bleeding risk assessments prior to the procedure, prophylactic administration of hemostatic agents for high-risk patients, and routine pre-biopsy utilization of color Doppler flow imaging and contrast-enhanced ultrasound to avoid vascular-rich areas during needle insertion. Similarly, the reduced pneumothorax rate likely stems from our practice of meticulously avoiding lesions exhibiting the "bronchus sign" during puncture, thereby minimizing the risk of pleural injury. In our study, we observed a higher incidence of early procedure termination when fewer samples (1–2 cores) were collected (P = 0.001). This finding supports the concept that complications may occur early in the procedure and are not necessarily dependent on the number of samples obtained [ 23 ]. Furthermore, this study revealed a positive correlation between lesion size and the number of specimens obtained (P < 0.001). We identified two potential explanations for this phenomenon: First, larger lesions may be associated with lower complication rates, which could enhance operator confidence and encourage a tendency to obtain additional samples. Second, larger lesions are more prone to necrosis, necessitating multiple passes by operators to ensure adequate sample collection . In our multivariate analysis examining the relationship between core sample quantity and complications, we identified a significant association between age and intolerable pain (P = 0.033), with older patients demonstrating better pain tolerance. This phenomenon may be potentially attributable to age-related neurodegenerative changes and slowed nociceptive transmission in elderly populations [ 24 ]. Our study has several limitations that should be acknowledged. First, as a single-center retrospective investigation, the study design may have facilitated the inclusion of confounding factors. Second, for outpatient cases, we only conducted telephone follow-ups within 24 hours post-procedure, meaning their delayed complications beyond this timeframe were not fully captured. Third, this study did not incorporate patients' pre-existing comorbidities into the analysis. Conclusion This study found no link between core sample quantity and complication risks in ultrasound-guided lung biopsies for cancer patients. These results are crucial for precision medicine: (1) Adequate tissue sampling is vital for NGS-driven molecular profiling and personalized treatment; (2) Multiple biopsies can be safely performed, overcoming traditional sampling limitations. Future multicenter studies should validate these findings and assess lesion-specific sampling impacts. Abbreviations US-PLCNB Ultrasound-Guided Percutaneous Lung Core Needle Biopsy SD Standard Deviation IQRs Interquartile Ranges PD-L1 Programmed Cell Death Ligand 1 Declarations Acknowledgements Not applicable. Author contributions M.S. and Y.W. designed the study; H.C. provided the data; J.S., Y.C. Y.Z.and H.Z. collected and analyzed the data; M.S. wrote the manuscript; Y.W. supervised the study. Funding This work was supported by the Shanghai Health Commission 2023 Shanghai Health Industry Clinical Research Special Project (Grant No. 202340246), National Natural Science Foundation of China (Grant No.82272007) and Shanghai Pulmonary Hospital National Natural Science Foundation Cultivation Project (Grant No. fkzr2466). Data availability The datasets used and analyzed in the current study are available from the corresponding author upon reasonable request. Ethics approval and consent to participate This study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board of Shanghai Pulmonary Hospital, China (approval number K18-197Y). Written informed consent was obtained from all patients. Consent for publication Not applicable. Competing interests The authors declare no competing interests. Clinical trial number Not applicable. References Lindeman N I, Cagle P T, Aisner D L, et al. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6435769","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":453280885,"identity":"d92aef6c-0d56-4573-b778-b18e23b0eb26","order_by":0,"name":"Mengjun Shen","email":"","orcid":"","institution":"Tongji University","correspondingAuthor":false,"prefix":"","firstName":"Mengjun","middleName":"","lastName":"Shen","suffix":""},{"id":453280888,"identity":"322ed743-f35e-4162-99b4-3fd122338711","order_by":1,"name":"Hongwei Chen","email":"","orcid":"","institution":"Tongji University","correspondingAuthor":false,"prefix":"","firstName":"Hongwei","middleName":"","lastName":"Chen","suffix":""},{"id":453280889,"identity":"8c785e58-5400-4466-88d5-32da77e28043","order_by":2,"name":"Jixin Shu","email":"","orcid":"","institution":"Tongji University","correspondingAuthor":false,"prefix":"","firstName":"Jixin","middleName":"","lastName":"Shu","suffix":""},{"id":453280890,"identity":"a92eda04-1fad-4080-b994-8b1689e115b5","order_by":3,"name":"Yang Cong","email":"","orcid":"","institution":"Tongji University","correspondingAuthor":false,"prefix":"","firstName":"Yang","middleName":"","lastName":"Cong","suffix":""},{"id":453280894,"identity":"5cbe44b7-2d4b-4b52-9a48-63950276976e","order_by":4,"name":"Yi Zhang","email":"","orcid":"","institution":"Tongji University","correspondingAuthor":false,"prefix":"","firstName":"Yi","middleName":"","lastName":"Zhang","suffix":""},{"id":453280896,"identity":"9544bef5-e60f-496b-8961-4bccd96f53c3","order_by":5,"name":"Huiming Zhu","email":"","orcid":"","institution":"Tongji University","correspondingAuthor":false,"prefix":"","firstName":"Huiming","middleName":"","lastName":"Zhu","suffix":""},{"id":453280897,"identity":"2d938150-a616-45c2-bc18-420d7fa448c3","order_by":6,"name":"Yin Wang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAqElEQVRIiWNgGAWjYBACPgYeNoYHFQwybERrYQNpSTgDIknSktjGwEO8w9ike489SJxnx8MnkWP2gKHGJpqwFplz6QaJ25J52CRyzA0YjqXlNhDUAjRcInEbMw+YwdhwmFgtc+pJ1tJwmBQtIL8kHDvOw8bzrEwigRi/8INC7ENNtZx8e/I2iQ81NoS1MEjAGAIJDAwJBJWjaOE/QJT6UTAKRsEoGIEAADxPMoikqSWjAAAAAElFTkSuQmCC","orcid":"","institution":"Tongji University","correspondingAuthor":true,"prefix":"","firstName":"Yin","middleName":"","lastName":"Wang","suffix":""}],"badges":[],"createdAt":"2025-04-12 16:53:58","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6435769/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6435769/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":82276545,"identity":"17f02a06-58b8-4e3a-91c6-d07e914ab324","added_by":"auto","created_at":"2025-05-08 14:46:30","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":919281,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6435769/v1/82e591ee-c433-423a-8c62-46709d293524.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Association Between Core Number and Complications in Ultrasound-Guided Percutaneous Lung Core Needle Biopsy: A Retrospective Study","fulltext":[{"header":"Background","content":"\u003cp\u003eWhile pathologists can diagnose pulmonary malignancies through morphological evaluation of minimal tissue samples [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], the rapid advancement of immunotherapy and precision therapies based on genomic profiling has precipitated a paradigm shift in tissue requirements. The exponential growth in biomarker targets requiring assessment\u0026mdash;from programmed cell death ligand 1 (PD-L1) expression to driver mutations\u0026mdash;has driven an unprecedented demand for larger biopsy volumes [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. This paradigm evolution mandates the procurement of multiple core specimens to satisfy both diagnostic verification and comprehensive molecular profiling needs [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], thereby raising critical clinical questions regarding the safety implications of expanded sampling protocols.\u003c/p\u003e \u003cp\u003eAlthough CT-guided lung biopsy is widely used for peripheral pulmonary lesions, ultrasound-guided is gaining increasing popularity [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Ultrasound-guided percutaneous lung core needle biopsy(US-PLCNB) can be performed when the lesion is in contact with the pleura or when there is consolidation between the lesion and the pleura. Compared to CT-guided, US-PLCNB is a radiation-free, real-time, and cost-effective bedside procedure that allows operators to avoid blood vessels or necrotic areas during needle insertion using Doppler ultrasound or contrast-enhanced ultrasound [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Although US-PLCNB is highly safe and minimally invasive, as an invasive diagnostic procedure, it still carries risks of needle-related complications during radiologist-performed punctures, such as hemoptysis, pneumothorax, and in severe cases, even fatal outcomes [\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn a meta-analysis of 12 studies [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] involving 3,830 patients who underwent ultrasound-guided percutaneous lung core needle biopsies, the most common complications were self-limited hemoptysis (2.3%) and asymptomatic pneumothorax (1.2%). Only 6 cases of pneumothorax requiring chest tube drainage and 1 case of severe hemorrhage were reported. Factors associated with an increased risk of post-biopsy hemoptysis, pneumothorax, or perilesional bleeding included smaller lesion size, shorter pleural contact length, bronchus sign, and perilesional vessels [\u003cspan additionalcitationids=\"CR12 CR13\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Based on these findings, it is reasonable to hypothesize that increasing the number of core needle passes through the pleura and lung parenchyma may elevate complication rates. However, Charissa et al. [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], in a study of 827 patients undergoing CT-guided lung biopsies, similarly found no evidence of an association between the number of core biopsy samples obtained and post-procedural complications. Nevertheless, research evaluating the impact of the number of needle passes in US-PLCNB remains extremely limited. Therefore, this study aims to determine whether the core number obtained via US-PLCNB is associated with post-procedural complications.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eThis was a single centre retrospective study of US-PLCNB in patients. Informed consent was obtained from each patient prior to undergoing US-PLCNB. The study was conducted in accordance with the Declaration of Helsinki. Institutional review board approval was obtained.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003ePatients and Data Collection\u003c/h2\u003e \u003cp\u003e Consecutive patients aged over 18 years who underwent ultrasound-guided percutaneous lung biopsy (US-PTNB) for suspected primary lung cancer at Shanghai Pulmonary Hospital between July 2019 and September 2021 were included. A retrospective review was conducted on all US-PTNB procedures, intraoperative ultrasound images, patient and procedural data recorded in the electronic medical records (eHis), and pathological reports of biopsy specimens. Data collection was performed by six trained researchers (MS, HC, JS, YC, YZ, HZ) and included: (1) gender, (2) age, (3) lesion size (longest diameter: \u0026le;3 cm, \u0026gt;\u0026thinsp;3 cm), (4) core number. Post-procedural complications were recorded, including type (hemoptysis, pneumothorax, pleural reaction, intolerable pain, hemothorax, delayed hemopneumothorax). Patients with non-pulmonary metastatic malignancies, benign lesions, or incomplete medical records were excluded. All cases were pathologically confirmed (via biopsy or surgery).\u003c/p\u003e \u003cp\u003eExclusion criteria for US-PLCNB were: Patients with severe psychiatric disorders unable to cooperate with the procedure; Patients or family members refusing the procedure; Patients with uncorrectable coagulopathy (INR\u0026thinsp;\u0026gt;\u0026thinsp;1.5 or platelet count\u0026thinsp;\u0026lt;\u0026thinsp;50 \u0026times;10⁹/L); Patients taking anticoagulants or antiplatelet agents within one week prior to biopsy; Patients with severe respiratory or circulatory failure. Patients presenting with any of the above contraindications were excluded from undergoing biopsy.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eProcedure\u003c/h3\u003e\n\u003cp\u003eExaminers utilized the LOGIQ E9 ultrasound system (GE Healthcare) equipped with a 1\u0026ndash;6 MHz convex probe to independently conduct ultrasound examinations.\u003c/p\u003e \u003cp\u003eGeneral considerations for needle entry included avoiding traversal of interlobar fissures, selecting the shortest path to the lesion, and circumventing blood vessels and bronchi along the needle trajectory, ideally positioning the lesion in a dependent or accessible location. After skin disinfection, 2% lidocaine was administered subcutaneously using a 22-gauge needle. A biopsy device (Bard Mission; BD Biosciences) with a 12 mm or 22 mm throw and 18G or 16G gauge (adjusted based on lesion size) was deployed. Needle lengths ranged from 10 cm to 16 cm, tailored to the patient\u0026rsquo;s body habitus and lesion depth/location. In select cases, a Bard coaxial introducer needle was utilized as a guiding sheath, depending on the biopsy device configuration. Under real-time ultrasound guidance, the biopsy needle was advanced toward the target subpleural pulmonary lesions. Radiologists employed a freehand technique for needle manipulation. If gross inspection suggested inadequate or non-diagnostic samples, additional cores were obtained. Post-procedural protocol: Patients were instructed to maintain strict bed rest for 30 minutes with ice pack application to the puncture site for hemostasis. A 30-minute follow-up ultrasound was performed to evaluate for hemorrhage or pneumothorax. If no complications were identified: hospitalized patients returned to their wards; Outpatients were discharged after 2 hours of observation, with instructions to seek emergency care immediately for acute pain or hemodynamic instability (e.g., hypotension, tachycardia).\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eDescriptive statistics were used. Quantitative data are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD) or median and interquartile ranges (IQRs). Categorical data are expressed as counts and percentages.\u003c/p\u003e \u003cp\u003eA linear-by-linear association test was employed to evaluate correlations between the number of samples obtained and binary variables (gender, premature procedure termination, diagnostic biopsy, hemoptysis, pneumothorax, intolerable pain, pleural reaction, hemothorax, delayed hemopneumothorax). Kendall\u0026rsquo;s tau-b correlation coefficient was used to assess the relationship between the number of samples and continuous variables (age, lesion size).\u003c/p\u003e \u003cp\u003eMultivariate logistic regression models, adjusted for clinical and procedural characteristics, were applied to determine whether the number of cores was independently associated with the incidence of complications (hemoptysis, pneumothorax, pleural reaction, intolerable pain, hemothorax, delayed hemopneumothorax). A P value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant. All analyses were performed using IBM SPSS Statistics, Version 27.0.\u003c/p\u003e \u003c/div\u003e"},{"header":"Result","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003ePatient Characteristics and Complication Rates\u003c/h2\u003e \u003cp\u003eThe initial study cohort included 1,544 patients who underwent ultrasound-guided biopsies during the study period. 393 patients were excluded (Fig.\u0026nbsp;3): 368 patients (23.83% ) had pulmonary metastatic lesions, 14 patients (0.91%) had benign lesions, 11 patients (0.71%) had incomplete medical records.\u003c/p\u003e \u003cp\u003eThe final analysis included 1,151/1,544 patients (74.55%) (mean age, 64.47\u0026thinsp;\u0026plusmn;\u0026thinsp;10.58 years [SD]; 278 [24.15%] females; 873 [75.85%] males) with pulmonary lesions suspected of primary lung cancer who underwent ultrasound-guided lung biopsies. The overall diagnostic accuracy rate was 97.22% (1,119/1,151). Among the 1,151 diagnostic biopsies, 417 (36.23%) were pathologically confirmed as lung adenocarcinoma, and 322 (27.98%) as lung squamous cell carcinoma (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Overall complications occurred in 41/1,151 cases (3.56%), with hemoptysis in 26 of 1,151(2.26%), pneumothorax in 7 of 1,151 (0.61%), intolerable pain in 3 of 1,151 (0.26%), pleural reaction in 2 of 1,151 (0.17%), hemothorax in 2 of 1,151 (0.17%), delayed hemopneumothorax in 1 of 1,151 (0.09%) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). No air embolism or mortality occurred in the study. The median number of core biopsy passes was 3 (range: 1\u0026ndash;7).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePatient Characteristics, Puncture Characteristics, and Postprocedural Complications\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eValue\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean age (y)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e64.47\u0026thinsp;\u0026plusmn;\u0026thinsp;10.58(20\u0026ndash;96)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal no. of patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1151\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e278(24.15)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e873(75.85)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLesion size (mm)\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58(41\u0026thinsp;~\u0026thinsp;77)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiagnostic success\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1119(97.22)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistopathologic result\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdenocarcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e417(36.23)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSquamous cell carcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e322(27.98)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-small cell lung cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e154(13.38)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLung cancer (unclassified)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e78(6.78)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmall cell carcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e72(6.26)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLung cancer (poorly differentiated)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34(2.95)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003csup\u003e\u0026sect;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e74(6.43)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostprocedural complications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41(3.56)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHemoptysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26(2.26)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePneumothorax\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7(0.61)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnbearable pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3(0.26)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePleural reaction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2(0.17)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHemothorax\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2(0.17)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDelayed hemopneumothorax\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1(0.09)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003eNote.\u0026mdash;Unless otherwise indicated, data are numbers of patients. Data in parentheses are percentages.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003e\u003csup\u003e*\u003c/sup\u003e Value is mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD; value in parentheses is the range.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003e\u003csup\u003e\u0026dagger;\u003c/sup\u003e Data are medians; data in parentheses are IQRs.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003e\u003csup\u003e\u0026sect;\u003c/sup\u003e Other included neuroendocrine carcinoma, sarcoma, sarcomatoid carcinoma, lymphoma, adenosquamous carcinoma, metastatic carcinoma, etc.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn 4 patients, the procedure was terminated prematurely. These patients underwent 2 biopsy passes (range: 1\u0026ndash;2 passes). Reasons for early termination included pneumothorax in 2 of 4 (50%), intolerable pain in 1 of 4 (25%), pleural reaction in 1 of 4 (25%).\u003c/p\u003e \u003cp\u003eIn the univariate analysis, no significant associations were observed between the number of samples obtained and the incidence of hemoptysis (P\u0026thinsp;=\u0026thinsp;0.429), pneumothorax (P\u0026thinsp;=\u0026thinsp;0.804), intolerable pain (P\u0026thinsp;=\u0026thinsp;0.444), pleural reaction (P\u0026thinsp;=\u0026thinsp;1.000), hemothorax (P\u0026thinsp;=\u0026thinsp;1.000), or delayed hemopneumothorax (P\u0026thinsp;=\u0026thinsp;1.000) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Notably, a higher number of samples was obtained with larger lesion size (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001); the proportion of male patients increased with the number of samples obtained (P\u0026thinsp;=\u0026thinsp;0.028); premature procedure termination occurred exclusively in patients undergoing 1\u0026ndash;2 biopsy passes (P\u0026thinsp;=\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePatient characteristics and postoperative complications by the core number of US-PLCNB\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e \u003cp\u003eNo. of Samples\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOne\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;27)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTwo\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;221)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eThree\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;583)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFour or More\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;320)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e63(58\u0026thinsp;~\u0026thinsp;71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63(60\u0026thinsp;~\u0026thinsp;71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e66(60\u0026thinsp;~\u0026thinsp;71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e65(58\u0026thinsp;~\u0026thinsp;72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.522\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLesion size(mm)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43(31\u0026thinsp;~\u0026thinsp;57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50(37\u0026thinsp;~\u0026thinsp;74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e58(42\u0026thinsp;~\u0026thinsp;75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e64(46\u0026thinsp;~\u0026thinsp;86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale sex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16(59.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e161(72.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e445(76.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e251(78.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.028\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProcedure terminated early\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1(3.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(1.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiagnostic success\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25(92.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e215(97.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e570(97.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e309(96.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHemoptysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7(3.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14(2.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5(1.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.429\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePneumothorax\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(0.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2(0.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3(0.94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.804\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnbearable pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1(3.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(0.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1(0.31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.444\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePleural reaction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(0.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1(0.31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHemothorax\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2(0.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDelayed hemopneumothorax\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(0.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eNote.\u0026mdash;Data are numbers of patients; data in parentheses are percentages. US-PLCNB, Ultrasound-guided percutaneous lung core needle biopsy.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e* Data are medians; data in parentheses are IQRs.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eMultivariate Analysis of the Association Between Core Number and Complications\u003c/h2\u003e \u003cp\u003eMultivariate analysis revealed no evidence of an independent association between the number of cores obtained and the incidence of post-procedural complications: hemoptysis (OR\u0026thinsp;=\u0026thinsp;0.846, P\u0026thinsp;=\u0026thinsp;0.524), pneumothorax (OR\u0026thinsp;=\u0026thinsp;1.378, P\u0026thinsp;=\u0026thinsp;0.544), intolerable pain (OR\u0026thinsp;=\u0026thinsp;0.502, P\u0026thinsp;=\u0026thinsp;0.381), pleural reaction (OR\u0026thinsp;=\u0026thinsp;1.177, P\u0026thinsp;=\u0026thinsp;0.866), hemothorax (OR\u0026thinsp;=\u0026thinsp;1.116, P\u0026thinsp;=\u0026thinsp;0.906), delayed hemopneumothorax (OR\u0026thinsp;=\u0026thinsp;1.182, P\u0026thinsp;=\u0026thinsp;0.903) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Age was significantly associated with intolerable pain (OR\u0026thinsp;=\u0026thinsp;0.907, P\u0026thinsp;=\u0026thinsp;0.033) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariate logistic regression analysis of complications of US-PLCNB\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eB\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eWals\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003edf\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e Value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e95% CI for OR\u003c/p\u003e \u003cp\u003e95% CI for OR\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eLower\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eUpper\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHemoptysis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale sex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.188\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.486\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.150\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.698\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.207\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.466\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e3.129\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.353\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.553\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.989\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.953\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e1.026\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLesion size\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.522\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.217\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.990\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.974\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e1.006\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo. of samples\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.167\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.262\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.405\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.524\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.846\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.506\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e1.415\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConstant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-2.094\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.501\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.945\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.163\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.123\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePneumothorax\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale sex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.357\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.853\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.176\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.675\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.700\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.132\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e3.720\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.042\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.042\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.996\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.318\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.043\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.960\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e1.133\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLesion size\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.142\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.285\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.981\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.947\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e1.016\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo. of samples\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.321\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.529\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.368\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.544\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.378\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.489\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e3.886\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConstant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-7.567\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.386\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.994\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.025\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eUnbearable pain\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale sex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.976\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.298\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.566\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.452\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.377\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.030\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e4.792\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.098\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.046\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.545\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.033\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.907\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.829\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.992\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLesion size\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.027\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.027\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.313\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.973\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.923\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e1.026\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo. of samples\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.787\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.769\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.381\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.502\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.107\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e2.345\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConstant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.754\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.915\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.339\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e36.226\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePleural reaction\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale sex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-1.411\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.434\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.968\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.325\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.244\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e4.055\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.142\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.089\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.528\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.152\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.968\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e1.372\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLesion size\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.036\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.353\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.552\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.979\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.912\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e1.051\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo. of samples\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.163\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.963\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.029\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.866\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.177\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.178\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e7.77\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConstant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-14.715\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.362\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.995\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.046\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHemothorax\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale sex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15.198\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2095.556\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.994\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e3986264.888\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.073\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.027\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.870\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.988\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.856\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e1.141\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLesion size\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.084\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.050\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.799\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.094\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.919\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.833\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e1.015\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo. of samples\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.109\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.924\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.906\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.116\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.182\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e6.826\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConstant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-17.218\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2095.563\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.993\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDelayed hemopneumothorax\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale sex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14.114\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2189.357\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.995\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1347569.579\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.088\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.126\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.491\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.484\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.092\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.854\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e1.397\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLesion size\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.049\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.062\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.641\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.423\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.952\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.843\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e1.074\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo. of samples\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.168\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.368\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.903\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.182\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.081\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e17.272\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConstant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-25.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2189.379\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.991\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003eNote.\u0026mdash;The logistic regression models included all relevant patient and biopsy characteristics.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003eUS-PLCNB, Ultrasound-guided percutaneous lung core needle biopsy; B, coefficient; CI, confidence interval; df, degree of freedom; OR, odds ratio; SE, standard error; Wald, χ2 value.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eAdvances in lung cancer treatment now require more tissue samples than before, which may expose patients to additional complications during US-PLCNB. In a retrospective study of 1151 patients undergoing US-guided lung core biopsy for suspected primary lung cancer, no evidence was found of an independent correlation between the number of samples obtained and any postoperative complications: hemoptysis (OR\u0026thinsp;=\u0026thinsp;0.846, P\u0026thinsp;=\u0026thinsp;0.524), pneumothorax (OR\u0026thinsp;=\u0026thinsp;1.378, P\u0026thinsp;=\u0026thinsp;0.544), intolerable pain (OR\u0026thinsp;=\u0026thinsp;0.502, P\u0026thinsp;=\u0026thinsp;0.381), pleural reaction (OR\u0026thinsp;=\u0026thinsp;1.177, P\u0026thinsp;=\u0026thinsp;0.866), hemothorax (OR\u0026thinsp;=\u0026thinsp;1.116, P\u0026thinsp;=\u0026thinsp;0.906), and delayed hemopneumothorax (OR\u0026thinsp;=\u0026thinsp;1.182, P\u0026thinsp;=\u0026thinsp;0.903).\u003c/p\u003e \u003cp\u003eOptimizing lung biopsy sample acquisition holds significant clinical value for guiding precision medicine practices, particularly in the era of targeted therapies where adequate tumor tissue volume is essential for high-quality genomic analysis [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Existing evidence demonstrates that increasing biopsy sample quantity not only enhances the accuracy of tumor heterogeneity assessment\u0026mdash;such as providing more comprehensive characterization of PD-L1 spatial heterogeneity [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u0026mdash;but also directly impacts molecular testing efficacy. Clinical data reveal that three core-needle biopsies optimize diagnostic sensitivity for malignancy detection [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], while four or more biopsy cores simultaneously improve both sensitivity and specificity for successful next-generation sequencing [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The novel contribution of this study lies in demonstrating that even when exceeding four biopsy passes, there is no statistically significant increase in complication rates. Consequently, we propose adopting 4\u0026ndash;5 core-needle biopsies as a standardized protocol for patients requiring genomic profiling. This approach ensures sufficient tissue yield for molecular diagnostics while maintaining procedural safety.\u003c/p\u003e \u003cp\u003eOur findings demonstrate that hemoptysis and pneumothorax were the most common complications of US-guided lung biopsy in our study. The hemoptysis rate in our cohort was 2.26%, and the pneumothorax rate was 0.61%. These values fall within or are slightly lower than the ranges described in the literature (2.3\u0026ndash;5.1% for hemoptysis and 1\u0026ndash;6% for pneumothorax) [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. The lower incidence of hemoptysis at our institution may be attributed to our protocol of performing bleeding risk assessments prior to the procedure, prophylactic administration of hemostatic agents for high-risk patients, and routine pre-biopsy utilization of color Doppler flow imaging and contrast-enhanced ultrasound to avoid vascular-rich areas during needle insertion. Similarly, the reduced pneumothorax rate likely stems from our practice of meticulously avoiding lesions exhibiting the \"bronchus sign\" during puncture, thereby minimizing the risk of pleural injury.\u003c/p\u003e \u003cp\u003eIn our study, we observed a higher incidence of early procedure termination when fewer samples (1\u0026ndash;2 cores) were collected (P\u0026thinsp;=\u0026thinsp;0.001). This finding supports the concept that complications may occur early in the procedure and are not necessarily dependent on the number of samples obtained [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Furthermore, this study revealed a positive correlation between lesion size and the number of specimens obtained (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). We identified two potential explanations for this phenomenon: First, larger lesions may be associated with lower complication rates, which could enhance operator confidence and encourage a tendency to obtain additional samples. Second, larger lesions are more prone to necrosis, necessitating multiple passes by operators to ensure adequate sample collection .\u003c/p\u003e \u003cp\u003eIn our multivariate analysis examining the relationship between core sample quantity and complications, we identified a significant association between age and intolerable pain (P\u0026thinsp;=\u0026thinsp;0.033), with older patients demonstrating better pain tolerance. This phenomenon may be potentially attributable to age-related neurodegenerative changes and slowed nociceptive transmission in elderly populations [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOur study has several limitations that should be acknowledged. First, as a single-center retrospective investigation, the study design may have facilitated the inclusion of confounding factors. Second, for outpatient cases, we only conducted telephone follow-ups within 24 hours post-procedure, meaning their delayed complications beyond this timeframe were not fully captured. Third, this study did not incorporate patients' pre-existing comorbidities into the analysis.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study found no link between core sample quantity and complication risks in ultrasound-guided lung biopsies for cancer patients. These results are crucial for precision medicine: (1) Adequate tissue sampling is vital for NGS-driven molecular profiling and personalized treatment; (2) Multiple biopsies can be safely performed, overcoming traditional sampling limitations. Future multicenter studies should validate these findings and assess lesion-specific sampling impacts.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eUS-PLCNB \u0026nbsp;Ultrasound-Guided Percutaneous Lung Core Needle Biopsy\u003c/p\u003e\n\u003cp\u003eSD \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Standard Deviation \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIQRs \u0026nbsp; \u0026nbsp; \u0026nbsp; Interquartile Ranges\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePD-L1 \u0026nbsp; \u0026nbsp; \u0026nbsp;Programmed Cell Death Ligand 1\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eM.S. and Y.W. designed the study; H.C. provided the data; J.S., Y.C. Y.Z.and H.Z. collected and analyzed the data; M.S. wrote the manuscript; Y.W. supervised the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the Shanghai Health Commission 2023 Shanghai Health Industry Clinical Research Special Project (Grant No. 202340246), National Natural Science Foundation of China (Grant No.82272007) and Shanghai Pulmonary Hospital National Natural Science Foundation Cultivation Project (Grant No. fkzr2466).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and analyzed in the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board of Shanghai Pulmonary Hospital, China (approval number K18-197Y). Written informed consent was obtained from all patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eLindeman N I, Cagle P T, Aisner D L, et al. Updated molecular testing guideline for the selection of lung cancer patients for treatment with targeted tyrosine kinase inhibitors: guideline from the College of American Pathologists, the International Association for the Study of Lung Cancer, and the Association for Molecular Pathology. Archives of pathology \u0026amp; laboratory medicine, 2018; 142(3): 321-346.\u003c/li\u003e\n\u003cli\u003eNational Comprehensive Cancer Network. Non\u0026ndash;Small Cell Lung Cancer, Version 4.2024, NCCN Clinical Practice Guidelines in Oncology. Journal of the National Comprehensive Cancer Network, 22.4 (2024): 249-274.\u003c/li\u003e\n\u003cli\u003eUchimura K, Yanase K, Imabayashi T, et al. The Impact of Core Tissues on Successful Next-Generation Sequencing Analysis of Specimens Obtained through Endobronchial Ultrasound-Guided Transbronchial Needle Aspira[1]tion. Cancers (Basel), 2021;13(23):5879.\u003c/li\u003e\n\u003cli\u003eYamamoto N, Watanabe T, Yamada K, et al. Efficacy and safety of ultrasound (US) guided percutaneous needle biopsy for peripheral lung or pleural lesion: comparison with computed tomography (CT) guided needle biopsy. J Thorac Dis, 2019;11(3):936e43.\u003c/li\u003e\n\u003cli\u003eGuo YQ, Liao XH, Li ZX, et al. Ultrasound-guided percutaneous needle biopsy for peripheral pulmonary lesions: diagnostic accuracy and influencing factors. Ultrasound Med Biol, 2018; 44(5):1003e11.\u003c/li\u003e\n\u003cli\u003eShen M J, Bi K, Cong Y, et al. Application of Contrast‐Enhanced Ultrasound in the Differential Diagnosis of Benign and Malignant Subpleural Pulmonary Lesions. Journal of Ultrasound in Medicine, 2022; 41(5): 1147-1157.\u003c/li\u003e\n\u003cli\u003eDiBardino DM, Yarmus LB, Semaan RW. Transthoracic needle biopsy of the lung. Journal of thoracic disease, 2015; 7(Suppl 4):S304-316.\u003c/li\u003e\n\u003cli\u003eKhosla R, McLean AW, Smith JA. Ultrasound-guided versus computed tomography-scan guided biopsy of pleural-based lung lesions. Lung India : official organ of Indian Chest Society, 2016; 33(5):487-492.\u003c/li\u003e\n\u003cli\u003eLemieux S, Kim T, Pothier-Piccinin O, et al. Ultrasound-guided transthoracic needle biopsy of the lung: sensitivity and safety variables. European radiology, 2021; 31(11):8272-8281.\u003c/li\u003e\n\u003cli\u003eLi S, Yu LL, Li L, et al. Ultrasound-guided core-needle biopsy for peripheral pulmonary lesions: a systematic review and meta-analysis. Clinical Radiology, 2023, 78(10): 755-762.\u003c/li\u003e\n\u003cli\u003eImamine R, Kubo T, Akuta K, et al. Ultrasound-guided lung biopsy with coaxial technique: pleural contact length affects the occurrence of pneumothorax after first puncture. Japanese Journal of Radiology, 2022; 40(4): 404-411.\u003c/li\u003e\n\u003cli\u003eLemieux, Simon, Kim Taehoo, et al. Ultrasound-guided transthoracic needle biopsy of the lung: sensitivity and safety variables. European Radiology,2021; Vol.31(11): 8272-8281.\u003c/li\u003e\n\u003cli\u003eYamamoto N, Watanabe T, Yamada K, et al. Efficacy and safety of ultrasound (US) guided percutaneous needle biopsy for peripheral lung or pleural lesion: comparison with computed tomography (CT) guided needle biopsy. Journal of thoracic disease, 2019; 11(3): 936.\u003c/li\u003e\n\u003cli\u003eZhang Y, He L, Zhou X, et al. Hemoptysis complicating ultrasound-guided transthoracic needle lung biopsy: air bronchial sign is a risk predictor. J Thorac Dis, 2020 Jun;12(6):3167-3177. \u003c/li\u003e\n\u003cli\u003eKim CR, Sari MA, Grimaldi E, et al. CT-guided coaxial lung biopsy: Number of cores and association with complications. Radiology, 2024; 313(2): e232168.\u003c/li\u003e\n\u003cli\u003eSilk MT, Mikkilineni N, Silk TC, et al. Prospective Evaluation of Unpro[1]cessed Core Needle Biopsy DNA and RNA Yield from Lung, Liver, and Kidney Tumors: Implications for Cancer Genomics. Anal Cell Pathol (Amst), 2018;2018:2898962.\u003c/li\u003e\n\u003cli\u003eDrilon A, Wang L, Arcila ME, et al. Broad, Hybrid Capture-Based Next[1]Generation Sequencing Identifies Actionable Genomic Alterations in Lung Adenocarcinomas Otherwise Negative for Such Alterations by Other Genomic Testing Approaches. Clin Cancer Res, 2015;21(16):3631\u0026ndash;3639.\u003c/li\u003e\n\u003cli\u003eHaragan A, Field JK, Davies MPA, et al. Het[1]erogeneity of PD-L1 expression in non-small cell lung cancer: Implica[1]tions for specimen sampling in predicting treatment response. Lung Cancer, 2019;134:79\u0026ndash;84.\u003c/li\u003e\n\u003cli\u003eLim C, Lee KY, Kim YK, et al. CT-guided core biopsy of malig[1]nant lung lesions: how many needle passes are needed? J Med Imaging Radiat Oncol, 2013;57(6):652\u0026ndash;656.\u003c/li\u003e\n\u003cli\u003eUchimura K, Yanase K, Imabayashi T, et al. The Impact of Core Tissues on Successful Next-Generation Sequencing Analysis of Specimens Obtained through Endobronchial Ultrasound-Guided Transbronchial Needle Aspira[1]tion. Cancers (Basel), 2021;13(23):5879.\u003c/li\u003e\n\u003cli\u003eFu Y, Zhang YY, Cui LG, et al. Ultrasound-Guided Biopsy of Pleural-Based Pulmonary Lesions by Injection of Contrast-Enhancing Drugs. Frontiers in pharmacology, 2019; 10:960.\u003c/li\u003e\n\u003cli\u003eZhang H, Guang Y, He W, et al. Ultrasound-guided percutaneous needle biopsy skill for peripheral lung lesions and complications prevention. Journal of thoracic disease, 2020; 12(7):3697-3705.\u003c/li\u003e\n\u003cli\u003eBeck KS, Kim TJ, Lee KY, et al. CT-guided coaxial biopsy of malignant lung lesions: are cores from 20-gauge needle adequate for histologic diagnosis and molecular analysis? J Thorac Dis, 2019;11(3):753\u0026ndash;765.\u003c/li\u003e\n\u003cli\u003eLautenbacher S, Peters JH, Heesen M, et al. Age changes in pain perception: A systematic-review and meta-analysis of age effects on pain and tolerance thresholds. Neurosci Biobehav Rev, 2017 Apr; 75:104-113.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pulmonary-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pulm","sideBox":"Learn more about [BMC Pulmonary Medicine](http://bmcpulmmed.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pulm/default.aspx","title":"BMC Pulmonary Medicine","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Ultrasound-guided percutaneous lung core needle biopsy(US-PLCNB), Core number, Complications","lastPublishedDoi":"10.21203/rs.3.rs-6435769/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6435769/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eWith advances in lung cancer management, there is a growing need for larger tissue samples to enable tumor genomic analysis and characterization.This study aims to determine whether the core number obtained during Ultrasound-guided percutaneous lung core needle biopsy(US-PLCNB) is associated with post-procedural complications.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis retrospective study enrolled consecutive patients who underwent US-PLCNB for primary lung cancer at Shanghai Pulmonary Hospital between July 2019 and September 2021. Patient data were extracted from medical records, including demographics, lesion size, and core number. Post-procedural complications, including hemoptysis, pneumothorax, intolerable pain, pleural reaction, hemothorax, and delayed hemopneumothorax, were documented. Multivariate logistic regression models were used to evaluate whether the core number was an independent predictor of complications following US-PLCNB.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 1,151 patients (mean age, 64.47\u0026thinsp;\u0026plusmn;\u0026thinsp;10.58 [SD] years; 278 [24.15%] females and 873 [75.85%] males) were included. The median lesion size was 58 mm (IQR, 41\u0026ndash;77 mm). Among the 1,151 patients, 417 (36.23%) were diagnosed with lung adenocarcinoma, and 322 (27.98%) with lung squamous cell carcinoma. Post-procedural complications occurred in 41 patients (3.56%), including: hemoptysis (26 cases, 2.26%), pneumothorax (7 cases, 0.61%), intolerable pain (3 cases, 0.26%), pleural reaction (2 cases, 0.17%), hemothorax (2 cases, 0.17%), and delayed hemopneumothorax (1 case, 0.09%). The median number of biopsy cores obtained was 3 (range: 1\u0026ndash;7). Multivariate analysis revealed no evidence of an association between the number of cores and complications: hemoptysis (OR\u0026thinsp;=\u0026thinsp;0.846, P\u0026thinsp;=\u0026thinsp;0.524), pneumothorax (OR\u0026thinsp;=\u0026thinsp;1.378, P\u0026thinsp;=\u0026thinsp;0.544), intolerable pain (OR\u0026thinsp;=\u0026thinsp;0.502, P\u0026thinsp;=\u0026thinsp;0.381), pleural reaction (OR\u0026thinsp;=\u0026thinsp;1.177, P\u0026thinsp;=\u0026thinsp;0.866), hemothorax (OR\u0026thinsp;=\u0026thinsp;1.116, P\u0026thinsp;=\u0026thinsp;0.906), delayed hemopneumothorax (OR\u0026thinsp;=\u0026thinsp;1.182, P\u0026thinsp;=\u0026thinsp;0.903).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eIn patients undergoing US-PLCNB for primary lung cancer, no evidence was found of an association between the core number biopsy samples obtained and post-procedural complications.\u003c/p\u003e","manuscriptTitle":"The Association Between Core Number and Complications in Ultrasound-Guided Percutaneous Lung Core Needle Biopsy: A Retrospective Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-08 14:30:25","doi":"10.21203/rs.3.rs-6435769/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-06-09T17:26:28+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-28T13:33:38+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-27T19:55:31+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"18152404991203793071236185280083540821","date":"2025-05-22T07:53:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"136707833353218505168920488050344251730","date":"2025-05-20T07:28:56+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-13T07:30:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"338499829417168951821955987992857000726","date":"2025-05-05T22:53:13+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-05T13:01:12+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-04-15T12:18:35+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-04-15T09:33:15+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-15T09:32:48+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pulmonary Medicine","date":"2025-04-12T16:49:16+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pulmonary-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pulm","sideBox":"Learn more about [BMC Pulmonary Medicine](http://bmcpulmmed.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pulm/default.aspx","title":"BMC Pulmonary Medicine","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f2753442-10f6-4c82-8034-991884083c8e","owner":[],"postedDate":"May 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-07-21T07:38:31+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-08 14:30:25","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6435769","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6435769","identity":"rs-6435769","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}