Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2012 Dec;29(4):319-24.
doi: 10.1055/s-0032-1330067.

Updates in percutaneous lung biopsy: new indications, techniques and controversies

Jonathan M Lorenz  1
Affiliations
Review

Updates in percutaneous lung biopsy: new indications, techniques and controversies

Jonathan M Lorenz. Semin Intervent Radiol. 2012 Dec.

Abstract

The objective of percutaneous chest biopsy is to consistently reach the amount of tissue required to meet or exceed published diagnostic accuracy rates. Many recent publications have reevaluated the subject of chest biopsy to assess borderline or controversial indications such as very small lesions, ground-glass opacities, and cases with a past nondiagnostic percutaneous biopsy. In addition, publications have reviewed sample adequacy for the accurate determination of molecular markers. These new indications promise to expand the numbers of biopsy procedures performed by radiologists. This article discusses the current role of image-guided percutaneous lung biopsies in the management of patients with pulmonary malignancies.

Keywords: interventional radiology; lung malignancy; molecular markers; percutaneous biopsy.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Computed tomography (CT)-guided biopsy of small intraparenchymal nodules. (A) Axial CT lung windows showing multiple subcentimeter nodules suspicious for metastatic disease. (B) Despite the small size, both core biopsy samples and fine-needle aspirates were obtained, and the diagnosis of metastatic squamous cell carcinoma of the head and neck was made. High rates of diagnostic accuracy have recently been reported for subcentimeter nodules.
Figure 2
Figure 2
Case illustrating the limitations of fluoroscopically guided lung biopsy. (A) A small nodule adjacent to the heart in the lingula is poorly visualized radiographically. (B) Computed tomography–guided core biopsy of this lesion, which resides partly within the chest wall, allows careful placement of the needle tip via a direct approach. In this case, by avoiding the posterior approach, the operator avoided crossing the pulmonary fissure. An anterior approach was attempted in an effort to minimize risk to the heart but was not possible due to a rib overlying the nodule.
Figure 3
Figure 3
Case illustrating the benefits of computed tomography (CT) fluoroscopy to biopsy small nodules behind ribs. (A, B) The nodule resides behind a rib on these two images obtained at two different points during the respiratory cycle. (C, D) Using CT fluoroscopy during suspended respirations, a 19-gauge introducer needle was quickly advanced around the rib and into the lesion.
See this image and copyright information in PMC

References

    1. Boiselle P M, Shepard J A, Mark E J. et al.Routine addition of an automated biopsy device to fine-needle aspiration of the lung: a prospective assessment. AJR Am J Roentgenol. 1997;169(3):661–666. - PubMed
    1. Gong Y, Sneige N, Guo M, Hicks M E, Moran C A. Transthoracic fine-needle aspiration vs concurrent core needle biopsy in diagnosis of intrathoracic lesions: a retrospective comparison of diagnostic accuracy. Am J Clin Pathol. 2006;125(3):438–444. - PubMed
    1. Libby D M, Smith J P, Altorki N K, Pasmantier M W, Yankelevitz D, Henschke C I. Managing the small pulmonary nodule discovered by CT. Chest. 2004;125(4):1522–1529. - PubMed
    1. Jae L I June I H Miyeon Y Kwanseop L Yul L Hoon B S Percutaneous core needle biopsy for small (≤10 mm) lung nodules: accurate diagnosis and complication rates Diagn Interv Radiol 2012; June 5 (Epub ahead of print) - PubMed
    1. Bladt O, De Wever W. Additional value of CT-fluoroscopic biopsy of pulmonary lesions: a retrospective study of 69 patients. JBR-BTR. 2006;89(6):298–302. - PubMed