Objective: Currently, computed tomography-guided percutaneous lung biopsy (CT-PLB) is widely applied in clinical practice for diagnosing pulmonary lesions. However, as an invasive procedure, it is prone to causing complications such as pneumothorax and pulmonary hemorrhage, which can even be life-threatening. This study aims to statistically analyze the incidence and associated risk factors of complications following CT-PLB, with the goal of reducing complication rates.

Methods: Studies reporting complications of CT-PLB from four databases between June 2020 and June 2025 were retrieved. A random-effects model was used to aggregate and compare the overall and major complication rates. Patients were categorized into groups based on complications: pneumothorax, pulmonary hemorrhage, concurrent pneumothorax and pulmonary hemorrhage, and no pneumothorax/pulmonary hemorrhage. Meta-regression analysis was performed to examine complication rates and identify risk factors influencing the occurrence of different complications.

Results: A total of 14 articles involving 3,127 procedures were included. The overall complication rate was 39.6% (95% CI: 35.6–44.5%). The incidence of pneumothorax was 37.1%, pulmonary hemorrhage was 30.2%, and concurrent pneumothorax and pulmonary hemorrhage was 10.5%. Risk factors for pneumothorax included the CT attenuation value in the needle trajectory region, the length of needle traversal through lung tissue, and the thickness of the chest wall traversed by the needle. Risk factors for pulmonary hemorrhage in non-subpleural lesions included the length of needle traversal through lung tissue, the average CT attenuation value in the needle trajectory region, lesion size, and patient positioning. Risk factors for concurrent pneumothorax and pulmonary hemorrhage included the length of needle traversal through lung tissue and the average CT attenuation value in the needle trajectory region.

Conclusion: CT-PLB is a safe, effective, and widely used diagnostic modality, particularly valuable for pulmonary space-occupying lesions. Minor complications such as pneumothorax and pulmonary hemorrhage are common but can be effectively reduced by selecting an appropriate biopsy approach, thereby improving diagnostic and therapeutic efficiency.