探讨肺结节-胸膜关系预测计算机断层扫描引导下肺穿刺活检(computed tomography-guided lung needle biopsy, CT-LNB)术后气胸风险的作用。

回顾性选择2021年1月至2024年12月我院收治的行CT-LNB肺结节患者111例为对象。根据CT-LNB术后是否发生气胸分组，发生气胸27例为观察组、未发生气胸84例为对照组。采用最小绝对收缩和选择算子(least absolute shrinkage and selection operator, LASSO)回归、多变量Logistic回归分析CT-LNB术后发生气胸的危险因素，构建列线图。

111例中结节接触胸膜32例，结节未接触胸膜29例(中位距离3.40 cm)，结节伴胸膜尾征(pleural tail sign, PTS)50例。观察组结节接触胸膜2例(7.41%)低于对照组30例(35.71%)(P＝0.005)；穿刺路径存在PTS 14例(51.85%)高于对照组17例(20.24%)(P＝0.001)。LASSO和Logistic回归分析显示，穿刺路径存在肺气肿(OR＝6.937，P＝0.031)、结节直径<2 cm(OR＝4.151，P＝0.020)、重复穿刺(OR＝3.479，P＝0.034)、肺内穿刺深度>2 cm(OR＝8.079，P＝0.011)、穿刺路径存在PTS(OR＝6.450，P＝0.005)是CT-LNB术后发生气胸的危险因素。受试者工作特征曲线(receiver operating characteristic, ROC)分析显示，列线图预测气胸风险曲线下面积(area under the curve, AUC)为0.88(95%CI：0.81~0.94)。临床决策曲线分析显示，高风险阈值0.05~0.78时，列线图预测气胸净临床收益较好。

穿刺路径存在PTS、肺气肿、肺结节直径<2 cm、重复穿刺、肺内穿刺深度>2 cm是CT-LNB术后发生气胸的危险因素。预测模型可为临床提供气胸个体化风险决策，对伴PTS肺结节行活检时避免穿过PTS穿刺轨迹，降低气胸风险。

To explore the role of the relationship between pulmonary nodules and pleura in the prediction of pneumothorax risk after computed tomography-guided lung needle biopsy (CT-LNB).

A retrospective selection was conducted on 111 patients with pulmonary nodules who underwent CT-LNB treatment in our hospital from January 2021 to December 2024. The patients were divided into groups based on whether pneumothorax occurred after CT-LNB surgery. 27 cases with pneumothorax were classified as the observation group, and 84 cases without pneumothorax were classified as the control group. Least absolute shrinkage and selection operator (LASSO) regression and multivariate Logistic regression were used to analyze the risk factors for pneumothorax after CT-LNB and to construct a nomogram.

Among the 111 cases, 32 cases had nodules in contact with the pleura, 29 cases had nodules not in contact with the pleura (with a median distance of 3.40 cm), and 50 cases had nodules with the pleural tail sign (PTS). In the observation group, 2 cases (7.41%) had nodules in contact with the pleura, which was lower than 30 cases (35.71%) in the control group (P=0.005); 14 cases (51.85%) in the observation group had PTS in the puncture path, which was higher than 17 cases (20.24%) in the control group (P=0.001). LASSO and Logistic regression analysis showed that the presence of PTS in the puncture path (OR=6.450, P=0.005), nodule diameter <2 cm (OR=4.151, P=0.020), repeated puncture (OR=3.479, P=0.034), intrapulmonary puncture depth >2 cm (OR=8.079, P=0.011), and PTS in the puncture path were risk factors for pneumothorax after CT-LNB. Receiver operating characteristic (ROC) curve analysis showed that the area under the curve (AUC)for predicting pneumothorax by the nomogram was 0.88 (95%CI: 0.81~0.94). Clinical decision curve analysis showed that when the high-risk threshold was 0.05~0.78, the nomogram had better net clinical benefit for predicting pneumothorax.

The presence of PTS in the puncture path, emphysema, nodule diameter <2 cm, repeated puncture, and intrapulmonary puncture depth >2 cm are risk factors for pneumothorax after CT-LNB surgery. The pneumothorax risk prediction model may be used clinically for individualized risk decision-making for pneumothorax, and when performing biopsy on pulmonary nodules with PTS, avoid puncturing through the PTS puncture trajectory to reduce the risk of pneumothorax.