Efficacy of Large-Particle Gelatin Sponge Slurry for Tract Embolization in Preventing Pneumothorax After Percutaneous Lung Biopsy in Pulmonary Emphysema

Efficacy of Large-Particle Gelatin Sponge Slurry for Tract Embolization in Preventing Pneumothorax After Percutaneous Lung Biopsy in Pulmonary Emphysema | 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 Article Efficacy of Large-Particle Gelatin Sponge Slurry for Tract Embolization in Preventing Pneumothorax After Percutaneous Lung Biopsy in Pulmonary Emphysema Aijun Huang, Wenyue Wu, Changhong Yi, Ming Xia, Chunlin Li This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7691948/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective To evaluate the safety and efficacy of needle tract embolization using large-particle (i.e.,1400–2000µm) gelatin sponge slurry (ELS) in preventing pneumothorax after percutaneous lung biopsy in patients with pulmonary emphysema. Methods A total of 1,487 patients with pulmonary emphysema who underwent percutaneous lung biopsy were included in this retrospective study. Baseline characteristics, procedural details, and complications were compared between the two groups. Multivariate logistic regression was performed to identify independent predictors of pneumothorax. Results 592 patients received ELS, while 895 did not (non-ELS group). The overall pneumothorax rate was 24.2%. The pneumothorax rate was significantly lower in the ELS group compared to the non-ELS group (9.0% vs. 34.3%, p < 0.001). Multivariate analysis confirmed that ELS was the only independent protective factor against pneumothorax (OR = 0.191, 95% CI: 0.139–0.262, p < 0.001). Although chest drainage was less frequent in the ELS group (6.3% vs. 19.2%), there was no significant difference between the two groups (p = 0.027). Conclusion ELS significantly reduced the incidence of pneumothorax following percutaneous lung biopsy in patients with pulmonary emphysema and should be considered as a preventive measure in high-risk populations. Health sciences/Diseases Health sciences/Medical research Health sciences/Risk factors Percutaneous lung biopsy pneumothorax large-particle gelatin sponge slurry embolization pulmonary emphysema Figures Figure 1 Figure 2 Introduction Percutaneous lung biopsy (PLB) is a widely used diagnostic procedure for pulmonary nodules and masses 1 . However, it is associated with various complications, among which pneumothorax is the most common, occurring in approximately 10–40% of cases, with a subset requiring chest tube drainage 2 – 4 . Several techniques have been proposed to reduce the rate of pneumothorax, including rapid needle withdrawal, patient positioning, and tract embolization using various materials 5 – 8 . Gelatin sponge slurry has been used for decades in interventional radiology for hemostasis and vessel embolization 9 , 10 , and its application in sealing the needle tract post-PLB has shown promise in reducing air leakage 11 . Recent meta-analysis and randomized controlled study have confirmed that needle tract embolization with gelatin sponge significantly reduces the rates of pneumothorax and chest tube insertion 12 , 13 . Patients with underlying pulmonary emphysema are at a significantly elevated risk of pneumothorax due to impaired lung elasticity and air trapping 14 . Ruud et al. identified emphysema as an independent predictor of post-PLB pneumothorax, reporting a 92% increase in pneumothorax risk and an approximately fourfold higher rate of chest tube insertion in this population 3 . To date, only one single-center retrospective study by Yang et al. has specifically evaluated the safety and efficacy of tract embolization with gelatin sponge particles (1000–1400µm) in patients with emphysema 15 . Although their results demonstrated a significant reduction in pneumothorax and chest tube placement rates compared to the non-embolization group, the incidence of pneumothorax in the embolization cohort remained above 20%, which is still considered unacceptably high. Notably, given that 17–19G coaxial needles are commonly used in PLB, the 1000–1400 µm gelatin sponge particles may be insufficient to consistently and completely occlude the needle tract. Thus, the use of larger particles or manually prepared gelatin sponge slurry(e.g., 1400–2000µm) may improve the efficacy of tract embolization. Therefore, this study aims to evaluate the efficacy of gelatin sponge slurry for needle tract embolization in preventing pneumothorax after PLB in patients with pulmonary emphysema. Materials and Methods Study population: This multicenter retrospective study encompassed patients with pulmonary emphysema from the Cancer Hospital of Shantou University Medical College and the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, all of whom underwent percutaneous lung biopsy between July 2016 and July 2025, as summarized in Fig. 1 . Exclusion criteria consisted of: (1) concurrent percutaneous interventional procedures such as radiofrequency ablation; (2) biopsy performed using fine-needle aspiration or core needle biopsy without a coaxial needle system; and (3) patients undergoing concurrent biopsy of multiple lesions, to ensure a standardized assessment of procedural risks and outcomes specific to a single target lesion. The study received institutional review board approval of Cancer Hospital of Shantou University Medical College, and the requirement for informed consent was waived due to its retrospective design. This study was conducted in accordance with the Declaration of Helsinki. Pulmonary emphysema The diagnosis of pulmonary emphysema and its severity were determined by two radiologists, each with at least 10 years of experience, using the Goddard visual scoring system 16 . According to this system, each lung lobe is graded on a scale of 0 to 4 based on the percentage of the lobe affected by emphysema: Grade 0 (none): 0%; Grade 1 (mild): 1–25%; Grade 2 (moderate): 26–50%; Grade 3 (severe): 51–75%; Grade 4 (very severe): 76–100%. The overall emphysema severity for each patient was then expressed as the average level across all lung lobes. Percutaneous lung biopsy with or without ELS Percutaneous lung biopsy was performed under CT guidance using a coaxial technique. For patients in the ELS group, all procedures included needle tract embolization using a gelatin sponge slurry, as was shown in Fig. 2 . The 17G coaxial introducer needle (Argon Medical Devices, Plano, TX, USA) was advanced to the periphery of the target lesion. A 18G biopsy needle (BioPince, Argon Medical Devices, Plano, TX, USA) was then inserted through the coaxial sheath to sample the lesion. Following tissue acquisition, the introducer needle was slowly withdrawn while injecting gelatin sponge slurry to embolize the needle tract. The slurry was prepared by cutting gelatin sponge sheets (Guangzhou Kuai Kang Medical Instruments, Guangzhou, China) into particles approximately 1.4–2.0 mm in diameter or gelatin sponge particles (1400–2000µm, Hangzhou Alicon Pharm, Hangzhou, China), which were mixed with saline. A small amount of contrast agent was occasionally added to improve radiologic visibility. The non-ELS control group underwent standard needle withdrawal without tract embolization. Data collection and follow-up Baseline characteristics including age, gender, smoking history, lesion size, location, emphysema severity, needle path length, pleural angle, and number of samplings were recorded. Complications occurring immediately, within one hour after the procedure, or detected during the first postoperative week were documented 17 , 18 . These included pneumothorax, hemothorax, hemoptysis, and air embolism. Treatment-related information, such as the use of closed thoracic drainage and drainage duration, was also collected. Statistical Analysis Continuous variables were expressed as mean ± standard deviation or median with interquartile range, as appropriate, and compared using Student’s t-tests or analysis of variance. Categorical variables were compared using chi-square tests. Independent risk factors for pneumothorax were identified using multivariate logistic regression. A two-sided p-value < 0.05 was considered statistically significant. All statistical analyses were performed using SPSS Statistics version 25 (IBM, Armonk, NY, USA). Results Baseline Characteristics A total of 4,376 patients were assessed for eligibility. A total of 1487 patients with radiologically confirmed pulmonary emphysema were included. Of these, 592 patients underwent ELS, while 895 constituted the non-embolization control group (non-ELS). There were no significant differences between the ELS and non-ELS groups in terms of age, gender, smoking history, lesion size, distance from pleura, lesion location, body position, needle path length, or number of pleural surfaces crossed. However, the ELS group had more severe emphysema (p < 0.001), higher needle-pleura angle (p = 0.001) and underwent more frequent sampling (p < 0.001), as was shown in Table 1 . Table 1 Baseline characteristics in patients with or without needle tract embolization using large-particle gelatin sponge slurry (ELS) Patient groups All patients N = 1487 ELS N = 592 Non-ELS N = 895 P value Age, years 66.7 ± 8.5 66.9 ± 10.1 66.7 ± 7.3 0.659 Male/Female, n (%) 1035/452 (69.6/30.4) 421/171 (71.1/28.9) 614/281 (68.6/31.4) 0.303 History of smoking, n (%) 1050 (70.6) 436 (73.6) 614 (68.6) Lesion size (mm) 2.4 ± 1.3 2.4 ± 1.4 2.4 ± 1.3 0.806 Distance from pleura (mm) 2.7 ± 1.3 2.6 ± 1.3 2.7 ± 1.3 0.263 Position of the lesion 0.721 Left upper, n (%) 363 (24.4) 144 (24.3) 219(24.5) Left lower, n (%) 286 (19.2) 119 (20.1) 167(18.7) Right upper, n (%) 410 (27.6) 159 (26.9) 251(28.0) Right middle, n (%) 83 (5.6) 38 (6.4) 45(5.0) Right lower, n (%) 345 (23.2) 132 (22.3) 213(23.8) Degree of Emphysema < 0.001 Mild, n (%) 800 (53.8) 287 (48.5) 513 (57.3) Moderate, n (%) 499 (33.6) 193 (32.6) 306 (34.2) Severe, n (%) 139 (9.3) 81 (13.7) 58 (6.5) Very severe, n (%) 49 (3.3) 31(5.2) 18 (2.0) Body position 0.804 Supine, n (%) 845 (56.8) 332 (56.1) 513 (57.3) Prone, n (%) 528 (35.5) 222 (37.5) 306 (34.2) Lateral decubitus 114 (7.7) 38 (6.4) 76 (8.5) Needle path length (cm)† 3.7 ± 1.4 3.7 ± 1.4 3.8 ± 1.4 0.644 Needle-pleura angle(°) 67 ± 15 66 ± 16 68 ± 14 0.001 Number of visceral pleural surfaces crossed 0.845 1 1336 (89.8) 533 (90.0) 803 (89.7) 2 151 (10.2) 59 (10.0) 92 (10.3) Number of sampling < 0.001 1 223 (15.0) 127 (21.5) 96 (10.7) 2 762 (51.2) 270 (45.6) 492 (55.0) 3 464 (31.2) 175 (29.6) 289 (32.3) ≥ 4 38 (2.6) 20 (3.4) 18 (2.0) Tissue diagnosis 0.873 Cancer, n (%) 1140 (76.7) 451 (76.2) 689 (77.4) Benign, n (%) 315 (21.2) 129 (21.8) 186 (20.8) Inconclusive, n (%) 32 (2.2) 12 (2.0) 20 (2.2) † The needle path length is defined as the distance the needle traverses within the lung Complications after PLB The overall pneumothorax rate was 24.2%, as was shown in Table 2 . The ELS group had a significantly lower rate of pneumothorax (9.0% vs. 34.3%, p < 0.001). Although chest drainage was less frequent in the ELS group (6.3% vs. 19.2%), there was no significant difference between the two groups (p = 0.0.186). In addition, hemothorax (1.9% vs. 3.4%, p = 0.085) and hemoptysis (5.9% vs. 9.1%, p = 0.027) were less common in the ELS group. No air embolism or procedure-related death occurred in either group. Table 2 Comparison of the complications in patients with pulmonary emphysema with or without needle tract embolization using large-particle gelatin sponge slurry (ELS) after the percutaneous lung biopsy All patients N = 1487 ELS N = 592 Non-ELS N = 895 P value Pneumothorax, n (%) 360 (24.2) 53 (9.0) 307 (34.3) < 0.001 Chest drainage, n (%) 209 (14.1) 37 (6.3) 172 (19.2) 0.186 Duration of drainage, days 3.6 ± 1.9 3.6 ± 1.8 3.6 ± 1.9 0.930 Hemothorax, n (%) 41 (2.8%) 11 (1.9) 30 (3.4) 0.085 Hemoptysis, n (%) 116 (7.8%) 35(5.9) 81 (9.1) 0.027 Air embolism, n (%) 0 0 0 Univariate analyses for the risk of the post-PLB pneumothorax There were no significant differences between the patients with or without post-PLB pneumothorax in terms of age, gender, smoking history, lesion size, distance from pleura, lesion location, degree of emphysema, body position, needle path length, needle-pleura angle, number of pleural surfaces crossed, number of sampling, tissue diagnosis (Table 3 ). However, it was found that the proportion of ELS was lower in those who developed pneumothorax(14.7% vs. 47.8%, p < 0.001 ). Table 3 Baseline characteristics in patients with or without pneumothorax after percutaneous lung biopsy Patient groups Pneumothorax N = 360 No Pneumothorax N = 1127 P value Age, years 67.2 ± 7.9 66.6 ± 8.7 0.224 Male/Female, n (%) 258/102 (71.7/28.3) 777/350 (68.9/31.1) 0.328 History of smoking, n (%) 249 (69.2) 801 (71.1) 0.489 Lesion size (mm) 2.4 ± 1.2 2.4 ± 1.3 0.252 Distance from pleura (mm) 2.7 ± 1.4 2.7 ± 1.3 0.435 Position of the lesion 0.687 Left upper, n (%) 90 (25.0) 273 (24.2) Left lower, n (%) 66 (18.3) 220 (19.5) Right upper, n (%) 107 (29.7) 303 (26.9) Right middle, n (%) 16 (4.4) 67 (5.9) Right lower, n (%) 81 (22.5) 264 (23.4) Degree of Emphysema† 0.156 Mild, n (%) 202 (56.1) 598 (53.1) Moderate, n (%) 125 (34.7) 374 (33.2) Severe, n (%) 24 (6.7) 115 (10.2) Very severe, n (%) 9 (2.5) 40 (3.5) Body position 0.078 Supine, n (%) 198 (55.0) 647 (57.4) Prone, n (%) 142 (39.4) 386 (34.3) Lateral decubitus 20 (5.6) 94 (8.3) Needle path length (cm)† 3.8 ± 1.4 3.7 ± 1.4 0.464 Needle-pleura angle(°) 68 ± 15 67 ± 15 0.078 Number of visceral pleural surfaces crossed 0.275 1 318 (88.3) 1018 (90.3) 2 42 (11.7) 109 (9.7) Number of sampling 0.279 1 49 (13.6) 174 (15.4) 2 200 (55.6) 562 (49.9) 3 104 (28.9) 360 (31.9) ≥ 4 7 (1.9) 31 (2.8) Tissue diagnosis 0.476 Cancer, n (%) 269 (74.7) 871 (77.3) Benign, n (%) 81 (22.5) 234 (20.8) Inconclusive, n (%) 10 (2.8) 22 (2.0) ELS 53 (14.7) 539 (47.8) < 0.001 † The needle path length is defined as the distance the needle traverses within the lung Multivariate analyses for the risk of the post-PLB pneumothorax Subsequently, factors with a P value less than 0.20 in the univariate analysis were selected for multivariate logistic regression. These factors included the degree of Emphysema, body position, needle-pleura angle, and ELS (Table 4 ). The multivariate analysis identified ELS as the only independent protective factor against pneumothorax(OR = 0.191, 95% CI: 0.139–0.262, p < 0.001). Table 4 Multivariate analyses of factors for predictors for pneumothorax after percutaneous lung biopsy in patients with pulmonary emphysema Coefficient Standard. Error Wald Statistic DF P value OR 95% Confidence Interval for OR Lower Bound Upper Bound Degree of Emphysema† -0.026 0.086 0.091 1 0.763 0.975 0.824 1.153 Body position -0.021 0.099 0.043 1 0.835 0.980 0.807 1.189 Needle-pleura angle(°) 0.004 0.004 0.761 1 0.383 1.004 0.995 1.012 ELS -1.655 0.162 104.900 1 < 0.001 0.191 0.139 0.262 Constant -0.836 0.356 5.509 1 0.019 0.433 DF, degrees of freedom; OR, odds ratio Discussions This is the first multicenter study with the largest number of study population, in studying the embolization of the needle tract after PLB. In this study, we found that that embolization of the needle tract using relatively large gelatin sponge slurry(1400–2000µm) can significantly reduce the incidence of pneumothorax following PLB in patients with pulmonary emphysema. And multivariate logistic regression confirmed ELS as a strong independent protective factor against pneumothorax, reducing the risk by approximately 80.9%, underscoring its potential clinical utility in this high-risk population. In this study, the ELS group exhibited a pneumothorax rate of 9.0%, markedly lower than the 34.3% observed in the non-embolization group. These results align with and extend previous findings on tract embolization after PLB 11 , 12 , 19 . While Yang et al. reported that gelatin sponge particles (1000–1400µm) reduced pneumothorax rates after PLB in patients with emphysema, the incidence remained considerable (> 20%), potentially due to particle size mismatch relative to the coaxial needle caliber 15 . Our use of a manually prepared slurry with larger particles (1400–2000µm) appears to provide more effective tract sealing, as reflected in the markedly lower pneumothorax rate. This supports the mechanistic hypothesis that complete tract occlusion is essential for preventing air leakage, particularly in patients with emphysema who have reduced lung compliance and are prone to prolonged air leaks. Notably, the two groups were well-balanced in most baseline and procedural characteristics, which strengthens the internal validity of the study and supports the reliability of the observed treatment effects. Interestingly, patients in the ELS group presented with relatively more severe emphysema and more challenging needle trajectories. These factors are conventionally associated with a higher risk of complications 20 . Nevertheless, the ELS approach still demonstrated a significant protective effect against pneumothorax, even after accounting for these higher-risk conditions. This finding further underscores the potential efficacy of ELS and suggests that its benefits may be particularly impactful in more complex clinical scenarios. Furthermore, the observed reductions in both hemoptysis and hemothorax within the ELS group indicate that gelatin sponge embolization may confer an additional protective effect against procedure-related bleeding complications. This represents a clinically valuable ancillary benefit beyond its primary role in pneumothorax prevention. Although the differences did not achieve statistical significance in the present study, a consistent trend was noted: the ELS group demonstrated numerically lower rates of hemothorax, specifically 1.9% versus 3.4%, and hemoptysis, 5.9%compared to 9.1% when measured against the conventional non-embolization approach. These findings align with previous research by Grage et al., who similarly documented that the application of a dehydrated hydrogel plug resulted in an apparent reduction in the incidence of hemoptysis, from 6% down to 3%, following percutaneous lung biopsy 21 . It is noteworthy, however, that in both their study and ours, the observed decreases did not reach statistical significance, possibly due to sample size limitations or the relatively low baseline incidence of these events. Nevertheless, the consistent direction of effect across studies suggests a potential role for tract embolization techniques in mitigating bleeding-related complications 22 , 23 . Several limitations should be considered when interpreting the results. First, despite its multicenter design, this retrospective study remains susceptible to inherent selection bias and unmeasured confounding. Second, the follow-up was limited to the immediate post-procedural period and within one week for those who presented to the hospital with symptoms and underwent testing. However, it cannot be ruled out that some patients may have developed delayed pneumothorax without noticeable symptoms and thus were not captured. Finally, all included patients had radiologically confirmed emphysema. Therefore, whether larger particles could further enhance the efficacy of needle tract embolization in patients without emphysema remains uncertain. Prospective randomized trials are warranted to validate these findings and establish standardized protocols for ELS preparation and application. Conclusions Needle tract embolization using large-particle gelatin sponge slurry is an effective and safe method for reducing pneumothorax rates after percutaneous lung biopsy in patients with pulmonary emphysema. Its routine use should be considered in high-risk populations to improve procedural safety and reducing the need for chest tube drainage Declarations Competing Interests Statement: The authors declare no competing interests. Funding This work was supported by the Shantou Medical and Health Science and Technology Program (Grant Number: 250716176494133 to Chunlin Li). Author Contribution Conceptualization, supervision, funding acquisition, C.L.; data collection, W.W. and M.X.; formal analysis, C.Y.; writing original draft, A.H.; review and editing, A.H. and C.L.; Acknowledgement None Data Availability The datasets used and analyzed during the current study are available from the corresponding author on reasonable request. References Hwang, A. R. et al. Percutaneous Lung Biopsy Prevalence and Use of the Lung CT Scan and Reporting Data System in the Veterans Health Administration Lung Cancer Screening Program. Chest 166 , 1254–1257. 10.1016/j.chest.2024.06.009 (2024). Zuckerman, D. A. 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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-7691948","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":526438201,"identity":"0ab34a50-73b7-40ba-94cd-665a62b2621d","order_by":0,"name":"Aijun Huang","email":"","orcid":"","institution":"The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture","correspondingAuthor":false,"prefix":"","firstName":"Aijun","middleName":"","lastName":"Huang","suffix":""},{"id":526438202,"identity":"a36cc2cb-95a4-4c56-9efa-dc396b410a59","order_by":1,"name":"Wenyue Wu","email":"","orcid":"","institution":"Therapy，Cancer Hospital of Shantou University Medical College","correspondingAuthor":false,"prefix":"","firstName":"Wenyue","middleName":"","lastName":"Wu","suffix":""},{"id":526438203,"identity":"36f33db2-6575-4ffb-bec6-ce983fee71f8","order_by":2,"name":"Changhong Yi","email":"","orcid":"","institution":"Therapy，Cancer Hospital of Shantou University Medical College","correspondingAuthor":false,"prefix":"","firstName":"Changhong","middleName":"","lastName":"Yi","suffix":""},{"id":526438204,"identity":"9da28065-612f-470d-aeb5-9c429d45e47c","order_by":3,"name":"Ming Xia","email":"","orcid":"","institution":"The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture","correspondingAuthor":false,"prefix":"","firstName":"Ming","middleName":"","lastName":"Xia","suffix":""},{"id":526438206,"identity":"ce9e6a4a-72c6-4232-97e4-6fa80e9f9dca","order_by":4,"name":"Chunlin Li","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzUlEQVRIiWNgGAWjYBACPmYGNiBlwcPA3gAWYGwgpIUNokWCh4HnAFg1EVoYIFqAKIFYLezMzx7z7pCQMZd8/vwxD4ON7IYDzM8e4HcYm7kx7xkJHsvZOYbNPAxpxhsOsJkb4NfCwybN2ybBY3A7hxGo5XDihgM8bBLEabl5/CFQy39StNxgADnsADFa2Mwk54K0nMkxnDnHINl45mE2M7xa+PkPP5N422Zjb3D8+IMPbyrsZPuONz/DqwUNgIKKmQT1o2AUjIJRMAqwAwAiijm1TZupSgAAAABJRU5ErkJggg==","orcid":"","institution":"Therapy，Cancer Hospital of Shantou University Medical College","correspondingAuthor":true,"prefix":"","firstName":"Chunlin","middleName":"","lastName":"Li","suffix":""}],"badges":[],"createdAt":"2025-09-23 08:53:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7691948/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7691948/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":93341620,"identity":"0fe787b1-4317-4b2e-982a-e5d95f8c748f","added_by":"auto","created_at":"2025-10-12 14:38:46","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":4416839,"visible":true,"origin":"","legend":"","description":"","filename":"Manuscript.docx","url":"https://assets-eu.researchsquare.com/files/rs-7691948/v1/d6e58b20c8390989f17b5ed2.docx"},{"id":93341619,"identity":"f41d38b0-6d27-46f0-938e-457f150ebaf6","added_by":"auto","created_at":"2025-10-12 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14:38:48","extension":"png","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":39105,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7691948/v1/8e2f70e57d06e357215b4117.png"},{"id":93341621,"identity":"8c0a8116-bc42-49c9-8661-fe8f796d87ec","added_by":"auto","created_at":"2025-10-12 14:38:46","extension":"png","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":874814,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7691948/v1/19441fb9e3d3cc3aecdda936.png"},{"id":93343079,"identity":"ef1ebf57-ff14-456d-be80-8b105f55c81d","added_by":"auto","created_at":"2025-10-12 14:46:47","extension":"xml","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":96498,"visible":true,"origin":"","legend":"","description":"","filename":"42b66b93d03747ae8026f1ea63a5d7c11structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7691948/v1/bca320daf9de7116a5b0fa74.xml"},{"id":93341627,"identity":"541efaaa-ffa7-49f3-996a-629a854bf3e6","added_by":"auto","created_at":"2025-10-12 14:38:48","extension":"html","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":106374,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7691948/v1/1f2696c95894719020435e2a.html"},{"id":93341624,"identity":"b4af2ccb-9058-426b-8335-c5f0c81b57a1","added_by":"auto","created_at":"2025-10-12 14:38:47","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":48408,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart of patient selection and study enrollment.\u003c/p\u003e","description":"","filename":"Picture1.png","url":"https://assets-eu.researchsquare.com/files/rs-7691948/v1/572c7679a8199371500d70d3.png"},{"id":93341626,"identity":"491a191a-ffb1-48f2-9ed1-8852e25738b2","added_by":"auto","created_at":"2025-10-12 14:38:48","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":185393,"visible":true,"origin":"","legend":"\u003cp\u003eA 66-year-old male patient with moderate emphysema, a mass in the right lower lobe, and right pleural effusion underwent percutaneous lung biopsy. (A) Non-contrast CT scan before biopsy shows the mass in the right lower lobe. (B) Following the placement of the coaxial needle into the perilesional area, a biopsy was performed using a fully automated biopsy needle passed through the coaxial system. (C) The needle tract was embolized using a large-particle gelatin sponge slurry immediately after biopsy. No pneumothorax was observed on immediate post-procedural or follow-up imaging. (D) Pathological examination of the biopsy specimen confirmed lung adenocarcinoma.\u003c/p\u003e","description":"","filename":"Picture2.png","url":"https://assets-eu.researchsquare.com/files/rs-7691948/v1/adaae0a123078e7fc6d0f976.png"},{"id":95312502,"identity":"3c8f41c8-d7d3-424f-8925-cf47f44ba9e5","added_by":"auto","created_at":"2025-11-06 15:49:33","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1185196,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7691948/v1/88398d4e-6881-4707-935c-2aef119d1c29.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Efficacy of Large-Particle Gelatin Sponge Slurry for Tract Embolization in Preventing Pneumothorax After Percutaneous Lung Biopsy in Pulmonary Emphysema","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePercutaneous lung biopsy (PLB) is a widely used diagnostic procedure for pulmonary nodules and masses\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. However, it is associated with various complications, among which pneumothorax is the most common, occurring in approximately 10\u0026ndash;40% of cases, with a subset requiring chest tube drainage\u003csup\u003e\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. Several techniques have been proposed to reduce the rate of pneumothorax, including rapid needle withdrawal, patient positioning, and tract embolization using various materials\u003csup\u003e\u003cspan additionalcitationids=\"CR6 CR7\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. Gelatin sponge slurry has been used for decades in interventional radiology for hemostasis and vessel embolization\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e, and its application in sealing the needle tract post-PLB has shown promise in reducing air leakage\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. Recent meta-analysis and randomized controlled study have confirmed that needle tract embolization with gelatin sponge significantly reduces the rates of pneumothorax and chest tube insertion\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e,\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003ePatients with underlying pulmonary emphysema are at a significantly elevated risk of pneumothorax due to impaired lung elasticity and air trapping\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. Ruud et al. identified emphysema as an independent predictor of post-PLB pneumothorax, reporting a 92% increase in pneumothorax risk and an approximately fourfold higher rate of chest tube insertion in this population\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. To date, only one single-center retrospective study by Yang et al. has specifically evaluated the safety and efficacy of tract embolization with gelatin sponge particles (1000\u0026ndash;1400\u0026micro;m) in patients with emphysema\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e. Although their results demonstrated a significant reduction in pneumothorax and chest tube placement rates compared to the non-embolization group, the incidence of pneumothorax in the embolization cohort remained above 20%, which is still considered unacceptably high. Notably, given that 17\u0026ndash;19G coaxial needles are commonly used in PLB, the 1000\u0026ndash;1400 \u0026micro;m gelatin sponge particles may be insufficient to consistently and completely occlude the needle tract. Thus, the use of larger particles or manually prepared gelatin sponge slurry(e.g., 1400\u0026ndash;2000\u0026micro;m) may improve the efficacy of tract embolization. Therefore, this study aims to evaluate the efficacy of gelatin sponge slurry for needle tract embolization in preventing pneumothorax after PLB in patients with pulmonary emphysema.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy population:\u003c/h2\u003e\u003cp\u003eThis multicenter retrospective study encompassed patients with pulmonary emphysema from the Cancer Hospital of Shantou University Medical College and the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, all of whom underwent percutaneous lung biopsy between July 2016 and July 2025, as summarized in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Exclusion criteria consisted of: (1) concurrent percutaneous interventional procedures such as radiofrequency ablation; (2) biopsy performed using fine-needle aspiration or core needle biopsy without a coaxial needle system; and (3) patients undergoing concurrent biopsy of multiple lesions, to ensure a standardized assessment of procedural risks and outcomes specific to a single target lesion. The study received institutional review board approval of Cancer Hospital of Shantou University Medical College, and the requirement for informed consent was waived due to its retrospective design. This study was conducted in accordance with the Declaration of Helsinki.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003ePulmonary emphysema\u003c/h3\u003e\n\u003cp\u003eThe diagnosis of pulmonary emphysema and its severity were determined by two radiologists, each with at least 10 years of experience, using the Goddard visual scoring system\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e. According to this system, each lung lobe is graded on a scale of 0 to 4 based on the percentage of the lobe affected by emphysema: Grade 0 (none): 0%; Grade 1 (mild): 1\u0026ndash;25%; Grade 2 (moderate): 26\u0026ndash;50%; Grade 3 (severe): 51\u0026ndash;75%; Grade 4 (very severe): 76\u0026ndash;100%. The overall emphysema severity for each patient was then expressed as the average level across all lung lobes.\u003c/p\u003e\n\u003ch3\u003ePercutaneous lung biopsy with or without ELS\u003c/h3\u003e\n\u003cp\u003ePercutaneous lung biopsy was performed under CT guidance using a coaxial technique. For patients in the ELS group, all procedures included needle tract embolization using a gelatin sponge slurry, as was shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. The 17G coaxial introducer needle (Argon Medical Devices, Plano, TX, USA) was advanced to the periphery of the target lesion. A 18G biopsy needle (BioPince, Argon Medical Devices, Plano, TX, USA) was then inserted through the coaxial sheath to sample the lesion. Following tissue acquisition, the introducer needle was slowly withdrawn while injecting gelatin sponge slurry to embolize the needle tract. The slurry was prepared by cutting gelatin sponge sheets (Guangzhou Kuai Kang Medical Instruments, Guangzhou, China) into particles approximately 1.4\u0026ndash;2.0 mm in diameter or gelatin sponge particles (1400\u0026ndash;2000\u0026micro;m, Hangzhou Alicon Pharm, Hangzhou, China), which were mixed with saline. A small amount of contrast agent was occasionally added to improve radiologic visibility. The non-ELS control group underwent standard needle withdrawal without tract embolization.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\n\u003ch3\u003eData collection and follow-up\u003c/h3\u003e\n\u003cp\u003eBaseline characteristics including age, gender, smoking history, lesion size, location, emphysema severity, needle path length, pleural angle, and number of samplings were recorded. Complications occurring immediately, within one hour after the procedure, or detected during the first postoperative week were documented\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e,\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. These included pneumothorax, hemothorax, hemoptysis, and air embolism. Treatment-related information, such as the use of closed thoracic drainage and drainage duration, was also collected.\u003c/p\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eContinuous variables were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation or median with interquartile range, as appropriate, and compared using Student\u0026rsquo;s t-tests or analysis of variance. Categorical variables were compared using chi-square tests. Independent risk factors for pneumothorax were identified using multivariate logistic regression. A two-sided p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant. All statistical analyses were performed using SPSS Statistics version 25 (IBM, Armonk, NY, USA).\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003eBaseline Characteristics\u003c/h2\u003e\u003cp\u003eA total of 4,376 patients were assessed for eligibility. A total of 1487 patients with radiologically confirmed pulmonary emphysema were included. Of these, 592 patients underwent ELS, while 895 constituted the non-embolization control group (non-ELS). There were no significant differences between the ELS and non-ELS groups in terms of age, gender, smoking history, lesion size, distance from pleura, lesion location, body position, needle path length, or number of pleural surfaces crossed. However, the ELS group had more severe emphysema (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), higher needle-pleura angle (p\u0026thinsp;=\u0026thinsp;0.001) and underwent more frequent sampling (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), as was shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\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\u003eBaseline characteristics in patients with or without needle tract embolization using large-particle gelatin sponge slurry (ELS)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\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=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePatient groups\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAll patients\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;1487\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eELS\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;592\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNon-ELS\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;895\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP 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, years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e66.7\u0026thinsp;\u0026plusmn;\u0026thinsp;8.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e66.9\u0026thinsp;\u0026plusmn;\u0026thinsp;10.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e66.7\u0026thinsp;\u0026plusmn;\u0026thinsp;7.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.659\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale/Female, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1035/452\u003c/p\u003e\u003cp\u003e(69.6/30.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e421/171\u003c/p\u003e\u003cp\u003e(71.1/28.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e614/281\u003c/p\u003e\u003cp\u003e(68.6/31.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.303\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHistory of smoking, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1050 (70.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e436 (73.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e614 (68.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLesion size (mm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.806\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDistance from pleura (mm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.263\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePosition of the lesion\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=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.721\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLeft upper, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e363 (24.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e144 (24.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e219(24.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLeft lower, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e286 (19.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e119 (20.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e167(18.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRight upper, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e410 (27.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e159 (26.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e251(28.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRight middle, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e83 (5.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e38 (6.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e45(5.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRight lower, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e345 (23.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e132 (22.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e213(23.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDegree of Emphysema\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=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMild, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e800 (53.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e287 (48.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e513 (57.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModerate, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e499 (33.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e193 (32.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e306 (34.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSevere, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e139 (9.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e81 (13.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e58 (6.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVery severe, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e49 (3.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e31(5.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e18 (2.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBody position\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=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.804\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSupine, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e845 (56.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e332 (56.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e513 (57.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProne, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e528 (35.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e222 (37.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e306 (34.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLateral decubitus\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e114 (7.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e38 (6.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e76 (8.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNeedle path length (cm)\u0026dagger;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.644\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNeedle-pleura angle(\u0026deg;)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e67\u0026thinsp;\u0026plusmn;\u0026thinsp;15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e66\u0026thinsp;\u0026plusmn;\u0026thinsp;16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e68\u0026thinsp;\u0026plusmn;\u0026thinsp;14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNumber of visceral pleural surfaces crossed\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=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.845\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1336 (89.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e533 (90.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e803 (89.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e151 (10.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e59 (10.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e92 (10.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNumber of sampling\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=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e223 (15.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e127 (21.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e96 (10.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e762 (51.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e270 (45.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e492 (55.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e464 (31.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e175 (29.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e289 (32.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e38 (2.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20 (3.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e18 (2.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTissue diagnosis\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=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.873\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCancer, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1140 (76.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e451 (76.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e689 (77.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBenign, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e315 (21.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e129 (21.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e186 (20.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInconclusive, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e32 (2.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12 (2.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20 (2.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u0026dagger; The needle path length is defined as the distance the needle traverses within the lung\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eComplications after PLB\u003c/h3\u003e\n\u003cp\u003eThe overall pneumothorax rate was 24.2%, as was shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. The ELS group had a significantly lower rate of pneumothorax (9.0% vs. 34.3%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Although chest drainage was less frequent in the ELS group (6.3% vs. 19.2%), there was no significant difference between the two groups (p\u0026thinsp;=\u0026thinsp;0.0.186). In addition, hemothorax (1.9% vs. 3.4%, p\u0026thinsp;=\u0026thinsp;0.085) and hemoptysis (5.9% vs. 9.1%, p\u0026thinsp;=\u0026thinsp;0.027) were less common in the ELS group. No air embolism or procedure-related death occurred in either group.\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\u003eComparison of the complications in patients with pulmonary emphysema with or without needle tract embolization using large-particle gelatin sponge slurry (ELS) after the percutaneous lung biopsy\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\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=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAll patients\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;1487\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eELS\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;592\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNon-ELS\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;895\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePneumothorax, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e360 (24.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e53 (9.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e307 (34.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChest drainage, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e209 (14.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e37 (6.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e172 (19.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.186\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDuration of drainage, days\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.930\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHemothorax, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e41 (2.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11 (1.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e30 (3.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.085\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHemoptysis, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e116 (7.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e35(5.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e81 (9.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.027\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAir embolism, n (%)\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\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eUnivariate analyses for the risk of the post-PLB pneumothorax\u003c/h2\u003e\u003cp\u003eThere were no significant differences between the patients with or without post-PLB pneumothorax in terms of age, gender, smoking history, lesion size, distance from pleura, lesion location, degree of emphysema, body position, needle path length, needle-pleura angle, number of pleural surfaces crossed, number of sampling, tissue diagnosis (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). However, it was found that the proportion of ELS was lower in those who developed pneumothorax(14.7% vs. 47.8%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 ).\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\u003eBaseline characteristics in patients with or without pneumothorax after percutaneous lung biopsy\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\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=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePatient groups\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePneumothorax\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;360\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo Pneumothorax\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;1127\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP 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, years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e67.2\u0026thinsp;\u0026plusmn;\u0026thinsp;7.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e66.6\u0026thinsp;\u0026plusmn;\u0026thinsp;8.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.224\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale/Female, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e258/102\u003c/p\u003e\u003cp\u003e(71.7/28.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e777/350\u003c/p\u003e\u003cp\u003e(68.9/31.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.328\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHistory of smoking, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e249 (69.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e801 (71.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.489\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLesion size (mm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.252\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDistance from pleura (mm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.435\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePosition of the lesion\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=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.687\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLeft upper, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e90 (25.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e273 (24.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLeft lower, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e66 (18.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e220 (19.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRight upper, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e107 (29.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e303 (26.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRight middle, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e16 (4.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e67 (5.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRight lower, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e81 (22.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e264 (23.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDegree of Emphysema\u0026dagger;\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=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.156\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMild, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e202 (56.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e598 (53.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModerate, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e125 (34.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e374 (33.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSevere, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e24 (6.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e115 (10.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVery severe, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9 (2.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e40 (3.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBody position\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=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.078\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSupine, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e198 (55.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e647 (57.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProne, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e142 (39.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e386 (34.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLateral decubitus\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20 (5.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e94 (8.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNeedle path length (cm)\u0026dagger;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.464\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNeedle-pleura angle(\u0026deg;)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e68\u0026thinsp;\u0026plusmn;\u0026thinsp;15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e67\u0026thinsp;\u0026plusmn;\u0026thinsp;15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.078\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNumber of visceral pleural surfaces crossed\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=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.275\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e318 (88.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1018 (90.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e42 (11.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e109 (9.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNumber of sampling\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=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.279\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e49 (13.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e174 (15.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e200 (55.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e562 (49.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e104 (28.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e360 (31.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 (1.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e31 (2.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTissue diagnosis\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=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.476\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCancer, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e269 (74.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e871 (77.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBenign, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e81 (22.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e234 (20.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInconclusive, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10 (2.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22 (2.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eELS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e53 (14.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e539 (47.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u0026dagger; The needle path length is defined as the distance the needle traverses within the lung\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eMultivariate analyses for the risk of the post-PLB pneumothorax\u003c/h2\u003e\u003cp\u003eSubsequently, factors with a P value less than 0.20 in the univariate analysis were selected for multivariate logistic regression. These factors included the degree of Emphysema, body position, needle-pleura angle, and ELS (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). The multivariate analysis identified ELS as the only independent protective factor against pneumothorax(OR\u0026thinsp;=\u0026thinsp;0.191, 95% CI: 0.139\u0026ndash;0.262, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMultivariate analyses of factors for predictors for pneumothorax after percutaneous lung biopsy in patients with pulmonary emphysema\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=\"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=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eCoefficient\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eStandard. Error\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eWald\u003c/p\u003e\u003cp\u003eStatistic\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\u003eP 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% Confidence Interval for OR\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eLower Bound\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eUpper Bound\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDegree of Emphysema\u0026dagger;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.026\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.086\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.091\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.763\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.975\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.824\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1.153\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBody position\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.021\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.099\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.043\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.835\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.980\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.807\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1.189\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNeedle-pleura angle(\u0026deg;)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.004\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.004\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.761\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.383\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.004\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.995\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1.012\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eELS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-1.655\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.162\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e104.900\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.191\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.139\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.262\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=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.836\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.356\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.509\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.019\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.433\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\" colspan=\"9\" nameend=\"c9\" namest=\"c1\"\u003e\u003cp\u003eDF, degrees of freedom; OR, odds ratio\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussions","content":"\u003cp\u003eThis is the first multicenter study with the largest number of study population, in studying the embolization of the needle tract after PLB. In this study, we found that that embolization of the needle tract using relatively large gelatin sponge slurry(1400\u0026ndash;2000\u0026micro;m) can significantly reduce the incidence of pneumothorax following PLB in patients with pulmonary emphysema. And multivariate logistic regression confirmed ELS as a strong independent protective factor against pneumothorax, reducing the risk by approximately 80.9%, underscoring its potential clinical utility in this high-risk population.\u003c/p\u003e\u003cp\u003eIn this study, the ELS group exhibited a pneumothorax rate of 9.0%, markedly lower than the 34.3% observed in the non-embolization group. These results align with and extend previous findings on tract embolization after PLB\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e,\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e. While Yang et al. reported that gelatin sponge particles (1000\u0026ndash;1400\u0026micro;m) reduced pneumothorax rates after PLB in patients with emphysema, the incidence remained considerable (\u0026gt;\u0026thinsp;20%), potentially due to particle size mismatch relative to the coaxial needle caliber\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e. Our use of a manually prepared slurry with larger particles (1400\u0026ndash;2000\u0026micro;m) appears to provide more effective tract sealing, as reflected in the markedly lower pneumothorax rate. This supports the mechanistic hypothesis that complete tract occlusion is essential for preventing air leakage, particularly in patients with emphysema who have reduced lung compliance and are prone to prolonged air leaks.\u003c/p\u003e\u003cp\u003eNotably, the two groups were well-balanced in most baseline and procedural characteristics, which strengthens the internal validity of the study and supports the reliability of the observed treatment effects. Interestingly, patients in the ELS group presented with relatively more severe emphysema and more challenging needle trajectories. These factors are conventionally associated with a higher risk of complications\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e. Nevertheless, the ELS approach still demonstrated a significant protective effect against pneumothorax, even after accounting for these higher-risk conditions. This finding further underscores the potential efficacy of ELS and suggests that its benefits may be particularly impactful in more complex clinical scenarios.\u003c/p\u003e\u003cp\u003eFurthermore, the observed reductions in both hemoptysis and hemothorax within the ELS group indicate that gelatin sponge embolization may confer an additional protective effect against procedure-related bleeding complications. This represents a clinically valuable ancillary benefit beyond its primary role in pneumothorax prevention. Although the differences did not achieve statistical significance in the present study, a consistent trend was noted: the ELS group demonstrated numerically lower rates of hemothorax, specifically 1.9% versus 3.4%, and hemoptysis, 5.9%compared to 9.1% when measured against the conventional non-embolization approach. These findings align with previous research by Grage et al., who similarly documented that the application of a dehydrated hydrogel plug resulted in an apparent reduction in the incidence of hemoptysis, from 6% down to 3%, following percutaneous lung biopsy\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e. It is noteworthy, however, that in both their study and ours, the observed decreases did not reach statistical significance, possibly due to sample size limitations or the relatively low baseline incidence of these events. Nevertheless, the consistent direction of effect across studies suggests a potential role for tract embolization techniques in mitigating bleeding-related complications\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e,\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eSeveral limitations should be considered when interpreting the results. First, despite its multicenter design, this retrospective study remains susceptible to inherent selection bias and unmeasured confounding. Second, the follow-up was limited to the immediate post-procedural period and within one week for those who presented to the hospital with symptoms and underwent testing. However, it cannot be ruled out that some patients may have developed delayed pneumothorax without noticeable symptoms and thus were not captured. Finally, all included patients had radiologically confirmed emphysema. Therefore, whether larger particles could further enhance the efficacy of needle tract embolization in patients without emphysema remains uncertain. Prospective randomized trials are warranted to validate these findings and establish standardized protocols for ELS preparation and application.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eNeedle tract embolization using large-particle gelatin sponge slurry is an effective and safe method for reducing pneumothorax rates after percutaneous lung biopsy in patients with pulmonary emphysema. Its routine use should be considered in high-risk populations to improve procedural safety and reducing the need for chest tube drainage\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eCompeting Interests Statement:\u003c/h2\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eThis work was supported by the Shantou Medical and Health Science and Technology Program (Grant Number: 250716176494133 to Chunlin Li).\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eConceptualization, supervision, funding acquisition, C.L.; data collection, W.W. and M.X.; formal analysis, C.Y.; writing original draft, A.H.; review and editing, A.H. and C.L.;\u003c/p\u003e\n\u003ch2\u003eAcknowledgement\u003c/h2\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003ch2\u003eData Availability\u003c/h2\u003e\n\u003cp\u003eThe datasets used and analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eHwang, A. 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Subpleural injection of gelatin sponge particles to reduce pneumothorax incidence in CT-guided lung biopsies: a retrospective single-center case-control study. \u003cem\u003eBMC cancer\u003c/em\u003e. \u003cb\u003e25\u003c/b\u003e, 529. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12885-025-13911-9\u003c/span\u003e\u003cspan address=\"10.1186/s12885-025-13911-9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2025).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Percutaneous lung biopsy, pneumothorax, large-particle gelatin sponge slurry, embolization, pulmonary emphysema","lastPublishedDoi":"10.21203/rs.3.rs-7691948/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7691948/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e\u003cp\u003eTo evaluate the safety and efficacy of needle tract embolization using large-particle (i.e.,1400\u0026ndash;2000\u0026micro;m) gelatin sponge slurry (ELS) in preventing pneumothorax after percutaneous lung biopsy in patients with pulmonary emphysema.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA total of 1,487 patients with pulmonary emphysema who underwent percutaneous lung biopsy were included in this retrospective study. Baseline characteristics, procedural details, and complications were compared between the two groups. Multivariate logistic regression was performed to identify independent predictors of pneumothorax.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003e592 patients received ELS, while 895 did not (non-ELS group). The overall pneumothorax rate was 24.2%. The pneumothorax rate was significantly lower in the ELS group compared to the non-ELS group (9.0% vs. 34.3%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Multivariate analysis confirmed that ELS was the only independent protective factor against pneumothorax (OR\u0026thinsp;=\u0026thinsp;0.191, 95% CI: 0.139\u0026ndash;0.262, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Although chest drainage was less frequent in the ELS group (6.3% vs. 19.2%), there was no significant difference between the two groups (p\u0026thinsp;=\u0026thinsp;0.027).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eELS significantly reduced the incidence of pneumothorax following percutaneous lung biopsy in patients with pulmonary emphysema and should be considered as a preventive measure in high-risk populations.\u003c/p\u003e","manuscriptTitle":"Efficacy of Large-Particle Gelatin Sponge Slurry for Tract Embolization in Preventing Pneumothorax After Percutaneous Lung Biopsy in Pulmonary Emphysema","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-12 14:38:34","doi":"10.21203/rs.3.rs-7691948/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f9c7a3af-b967-4d28-bfac-0ac712ac53e2","owner":[],"postedDate":"October 12th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":55952469,"name":"Health sciences/Diseases"},{"id":55952470,"name":"Health sciences/Medical research"},{"id":55952471,"name":"Health sciences/Risk factors"}],"tags":[],"updatedAt":"2025-11-04T05:08:36+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-12 14:38:34","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7691948","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7691948","identity":"rs-7691948","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}