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We prospectively studied results of 103 consecutive transthoracic needle biopsies of lung lesions suspicious for malignancy to determine if lesion size, depth within the lung, hyperinflation, second needle passes, or 100 percent oxygen breathing influenced the incidence of pneumothorax. Thirty-eight patients (37 percent) developed pneumothorax. Ten (10 percent) required tube thoracostomy for re-expansion. ⋯ Oxygen breathing did not significantly reduce the incidence of pneumothorax, but may reduce size by increasing the rate of reabsorption. The other factors had little influence. We conclude that the more central location of the lesion and pre-existing lung hyperinflation determine the risk of pneumothorax.