Effect of smoking on the diagnostic results and complication rates of percutaneous transthoracic needle biopsy

Abstract Objective To investigate the association of smoking with the outcomes of percutaneous transthoracic needle biopsy (PTNB). Methods In total, 4668 PTNBs for pulmonary lesions were retrospectively identified. The associations of smoking status (never, former, current smokers) and smoking intensity (≤ 20, 21–40, > 40 pack-years) with diagnostic results (malignancy, non-diagnostic pathologies, and false-negative results in non-diagnostic pathologies) and complications (pneumothorax and hemoptysis) were assessed using multivariable logistic regression analysis. Results Among the 4668 PTNBs (median age of the patients, 66 years [interquartile range, 58–74]; 2715 men), malignancies, non-diagnostic pathologies, and specific benign pathologies were identified in 3054 (65.4%), 1282 (27.5%), and 332 PTNBs (7.1%), respectively. False-negative results for malignancy occurred in 20.5% (236/1153) of non-diagnostic pathologies with decidable reference standards. Current smoking was associated with malignancy (adjusted odds ratio [OR], 1.31; 95% confidence interval [CI]: 1.02–1.69; p = 0.03) and false-negative results (OR, 2.64; 95% CI: 1.32–5.28; p = 0.006), while heavy smoking (> 40 pack-years) was associated with non-diagnostic pathologies (OR, 1.69; 95% CI: 1.19–2.40; p = 0.003) and false-negative results (OR, 2.12; 95% CI: 1.17–3.92; p = 0.02). Pneumothorax and hemoptysis occurred in 21.8% (1018/4668) and 10.6% (495/4668) of PTNBs, respectively. Heavy smoking was associated with pneumothorax (OR, 1.33; 95% CI: 1.01–1.74; p = 0.04), while heavy smoking (OR, 0.64; 95% CI: 0.40–0.99; p = 0.048) and current smoking (OR, 0.64; 95% CI: 0.42–0.96; p = 0.04) were inversely associated with hemoptysis. Conclusion Smoking history was associated with the outcomes of PTNBs. Current and heavy smoking increased false-negative results and changed the complication rates of PTNBs. Clinical relevance statement Smoking status and intensity were independently associated with the outcomes of PTNBs. Non-diagnostic pathologies should be interpreted cautiously in current or heavy smokers. A patient’s smoking history should be ascertained before PTNB to predict and manage complications. Key Points • Smoking status and intensity might independently contribute to the diagnostic results and complications of PTNBs. • Current and heavy smoking (> 40 pack-years) were independently associated with the outcomes of PTNBs. • Operators need to recognize the association between smoking history and the outcomes of PTNBs.