Skip to main content

Percutaneous Transthoracic Lung Biopsy

  • Chapter
  • First Online:
Percutaneous Image-Guided Biopsy

Abstract

Percutaneous transthoracic needle biopsy (TNB) has emerged as a viable and minimally invasive procedure for the diagnosis of indeterminate pulmonary nodules, masses, and consolidations. Over the past two decades with continued improvements in small gauge coaxial core needle systems and biopsy technique, coaxial core biopsy is now a preferred technique for pulmonary lesions as it can obtain larger specimens for diagnosis and molecular analysis. Core needle samples are becoming increasingly important as recent advances in molecular profiling require adequate tumor tissue to identify specific mutations allowing for targeted cancer therapy and for accurate prognosis. With the continued improvement in imaging technology, needle design, biopsy technique, enhanced targeting, and strategies for preventing and managing potential complications, previously inaccessible pulmonary lesions can be biopsied in a safe and reliable manner. This chapter gives an overview of TNB including its indications, contraindications, the imaging modalities currently used for guidance, and the special techniques utilized in performing the procedure and minimizing complications.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Cham MD, Lane ME, Henschke CI, Yankelevitz DF. Lung biopsy: special techniques. Semin Respir Crit Care Med. 2008;29(4):335–49.

    Article  PubMed  Google Scholar 

  2. Moore EH. Percutaneous lung biopsy: an ordering clinician's guide to current practice. Semin Respir Crit Care Med. 2008;29(4):323–34.

    Article  PubMed  Google Scholar 

  3. Maemondo M, Inoue A, Kobayashi K, et al. Gefitinib or chemotherapy for non-small-cell lung cancer with mutated EGFR. N Engl J Med. 2010;362(25):2380–8.

    Article  PubMed  CAS  Google Scholar 

  4. Borczuk AC, Shah L, Pearson GD, et al. Molecular signatures in biopsy specimens of lung cancer. Am J Respir Crit Care Med. 2004;170(2):167–74.

    Article  PubMed  Google Scholar 

  5. Laurent F, Montaudon M, Latrabe V, et al. Percutaneous biopsy in lung cancer. Eur J Radiol. 2003;45:60–8.

    Article  PubMed  Google Scholar 

  6. Murphy JM, Gleeson FV, Flower CD. Percutaneous needle biopsy of the lung and its impact on patient management. World J Surg. 2001;25:373–80.

    Article  PubMed  CAS  Google Scholar 

  7. Klein JS, Zarka MA. Transthoracic needle biopsy. Radiol Clin North Am. 2000;38:235–66.

    Article  PubMed  CAS  Google Scholar 

  8. Manhire A, Charig M, Clelland C, et al. Guidelines for radiologically guided lung biopsy. Thorax. 2003;58(11):920–36.

    Article  PubMed  CAS  Google Scholar 

  9. Castellino RA, Blank N. Etiologic diagnosis of focal pulmonary infection in immunocompromised patients by fluoroscopically guided percutaneous needle aspiration. Radiology. 1979;132:563–7.

    PubMed  CAS  Google Scholar 

  10. Conces DJ, Clark SA, Tarver RD, et al. Transthoracic aspiration needle biopsy: value in the diagnosis of pulmonary infections. AJR Am J Roentgenol. 1989;152:31–4.

    Article  PubMed  Google Scholar 

  11. Hur J, Lee HJ, Nam JE, et al. Diagnostic accuracy of CT fluoroscopy-guided needle aspiration biopsy of ground-glass opacity pulmonary lesions. AJR Am J Roentgenol. 2009;192(3):629–34.

    Article  PubMed  Google Scholar 

  12. Kim TJ, Lee JH, Lee CT, et al. Diagnostic accuracy of CT-guided core biopsy of ground-glass opacity pulmonary lesions. AJR Am J Roentgenol. 2008;190:234–9.

    Article  PubMed  Google Scholar 

  13. Wallace MJ, Krishnamurthy S, Broemeling LD, et al. CT guided percutaneous fine-needle aspiration biopsy of small (< or ¼1-cm) pulmonary lesions. Radiology. 2002;225:823–8.

    Article  PubMed  Google Scholar 

  14. Charig MJ, Stutley JE, Padley SPG, et al. The value of negative needle biopsy in suspected operable lung cancer. Clin Radiol. 1991;44(3):147–9.

    Article  PubMed  CAS  Google Scholar 

  15. Wallace AB, Suh RD. Percutaneous transthoracic needle biopsy: special considerations and techniques used in lung transplant recipients. Semin Intervent Radiol. 2004;21(4):247–58; https://www.thieme-connect.com/ejournals/abstract/sir/doi/10.1055/s-2004-861559.

    Article  PubMed  Google Scholar 

  16. Aziz A, Ashizawa K, Nagaoki K, Hayashi K. High resolution CT anatomy of the pulmonary fissures. J Thorac Imaging. 2004;19:186–91.

    Article  PubMed  Google Scholar 

  17. Yildiz A, Gölpinar F, Calikoğlu M, Duce MN, Ozer C, Apaydin FD. HRCT evaluation of the accessory fissures of the lung. Eur J Radiol. 2004;49(3):245–9.

    Article  PubMed  Google Scholar 

  18. Moore EH. Technical aspects of needle aspiration lung biopsy: a personal perspective. Radiology. 1998;208:303–18.

    PubMed  CAS  Google Scholar 

  19. Cahill AM, Baskin KM, Kaye RD, Fitz CR, Towbin RB. CT-guided percutaneous lung biopsy in children. J Vasc Interv Radiol. 2004;15(9):955–60.

    Article  PubMed  Google Scholar 

  20. Yankelevitz DF, Henschke CI, Koizumi JH, et al. CT-guided transthoracic needle biopsy of small solitary pulmonary nodules. Clin Imaging. 1997;21:107–10. (alternative – Ng YL CT-Guided percut 2008).

    Article  PubMed  CAS  Google Scholar 

  21. Froelich JJ, Ishaque N, Regn J, et al. Guidance of percutaneous pulmonary biopsies with real-time CT fluoroscopy. Eur J Radiol. 2002;42:74–9.

    Article  PubMed  Google Scholar 

  22. Katada K, Kato R, Anno H, et al. Guidance with real-time CT fluoroscopy: early clinical experience. Radiology. 1996;200:851–6.

    PubMed  CAS  Google Scholar 

  23. Li H, Boiselle PM, Shepard JO. Diagnostic accuracy and safety of CT-guided percutaneous needle aspiration biopsy of the lung: comparison of small and large pulmonary nodules. AJR Am J Roentgenol. 1996;167:105–9.

    Article  PubMed  CAS  Google Scholar 

  24. Haramati LB. CT-guided automated needle biopsy of the chest. AJR Am J Roentgenol. 1995;165:53–5.

    Article  PubMed  CAS  Google Scholar 

  25. Greif J, Marmur S, Schwarz Y, et al. Percutaneous core cutting needle biopsy compared with fine-needle aspiration in the diagnosis of peripheral lung malignant lesions: results in 156 patients. Cancer. 1998;84:144–7.

    Article  PubMed  CAS  Google Scholar 

  26. Klein JS, Schultz S. Interventional chest radiology. Curr Probl Diagn Radiol. 1992;21:219–77.

    Article  PubMed  CAS  Google Scholar 

  27. Klein JS, Salomon G, Stewart EA. Transthoracic needle biopsy with a coaxially placed 20-gauge automated cutting needle: results in 122 patients. Radiology. 1996;198:715–20.

    PubMed  CAS  Google Scholar 

  28. Greif J, Marmur S, Schwarz Y, et al. Percutaneous core needle biopsy vs. fine-needle aspiration in diagnosing benign lung lesions. Acta Cytol. 1999;43:756–60.

    Article  PubMed  CAS  Google Scholar 

  29. Staroselsky AN, Schwarz Y, Man A, et al. Additional information from percutaneous cutting needle biopsy following fine-needle aspiration in the diagnosis of chest lesions. Chest. 1998;113:1522–5.

    Article  PubMed  CAS  Google Scholar 

  30. Yankelevitz DF, Vazquez M, Henschke CI. Special techniques in transthoracic needle biopsy of pulmonary nodules. Radiol Clin North Am. 2000;38:267–79.

    Article  PubMed  CAS  Google Scholar 

  31. Haramati LB, Austin JHM. Complications after CT-guided needle biopsy through aerated versus nonaerated lung. Radiology. 1991;181:778.

    PubMed  CAS  Google Scholar 

  32. Stern EJ, Webb WR, Gamsu G. CT gantry tilt: utility in transthoracic fine-needle aspiration biopsy. Radiology. 1993;187:873–4.

    PubMed  CAS  Google Scholar 

  33. Yankelevitz DF, Henschke CI, Davis SD. Percutaneous CT biopsy of chest lesions: an in vitro analysis of the effect of partial volume averaging on needle positioning. AJR Am J Roentgenol. 1993;161:273–8.

    Article  PubMed  CAS  Google Scholar 

  34. Sandhu J, Meglin AJ, Trerotola SO. Thoracic and visceral nonvascular interventions. Fairfax: The Society of Cardiovascular and Interventional Radiology; 1997. p. 159–70.

    Google Scholar 

  35. Klose KC. CT-guided large-bore biopsy: extrapleural injection of saline for safe transpleural access to pulmonary lesions. Cardiovasc Intervent Radiol. 1993;16:259–61.

    Article  PubMed  CAS  Google Scholar 

  36. Horton JA, Bank WO, Kerber CW. Guiding the thin spinal needle. AJR Am J Roentgenol. 1980;134:845–84.

    Article  PubMed  CAS  Google Scholar 

  37. Yankelevitz DF, Davis SD, Chiarella D, et al. Needle-tip repositioning during computed-tomography-guided transthoracic needle aspiration biopsy of small deep pulmonary lesions: minor adjustments make a big difference. J Thorac Imaging. 1996;11:279–82.

    Article  PubMed  CAS  Google Scholar 

  38. Ohno Y, Hatabu H, Takenaka D, Imai M, Ohbayashi C, Sugimura K. Transthoracic CT-guided biopsy with multiplanar reconstruction image improves diagnostic accuracy of solitary pulmonary nodules. Eur J Radiol. 2004;51(2):160–8.

    Article  PubMed  Google Scholar 

  39. Santos RS, Gupta A, Ebright MI. Electromagnetic navigation to aid radiofrequency ablation and biopsy of lung tumors. Ann Thorac Surg. 2010;89(1):265–8.

    Article  PubMed  Google Scholar 

  40. Layfield LJ, Liu K, Erasmus JJ. Radiologically determined diameter, pathologic diameter, and reactive zone surrounding pulmonary neoplasms: implications for transthoracic fine needle aspiration of pulmonary neoplasms. Diagn Cytopathol. 1999;21:250–2.

    Article  PubMed  CAS  Google Scholar 

  41. Aerospace Medical Association Medical Guidelines Task Force. Medical guidelines for airline travel, 2nd ed. Aviat Space Environ Med. 2003;74(5 Suppl):A1–19.

    Google Scholar 

  42. Moore EH, Shepard JO, McLoud TC, et al. Positional precautions in needle aspiration lung biopsy. Radiology. 1990;175:733–5.

    PubMed  CAS  Google Scholar 

  43. Berquist TH, Bailey PB, Cortese DA, et al. Transthoracic needle biopsy: accuracy and complications in relation to location and type of lesion. Mayo Clin Proc. 1980;55:475–81.

    PubMed  CAS  Google Scholar 

  44. Fish GD, Stanley JH, Miller S, et al. Postbiopsy pneumothorax: estimating the risk by chest radiography and pulmonary function tests. AJR Am J Roentgenol. 1988;150:71–4.

    Article  PubMed  CAS  Google Scholar 

  45. Yankelevitz DF, Davis SD, Henschke CI. Aspiration of a large pneumothorax resulting from transthoracic needle biopsy. Radiology. 1996;200:695–7.

    PubMed  CAS  Google Scholar 

  46. Yamagami T, Nakamura T, Iida S, et al. Management of pneumothorax after percutaneous CT-guided lung biopsy. Chest. 2002;121:1159–64.

    Article  PubMed  Google Scholar 

  47. Lang EK, Ghavami R, Schreiner VC, et al. Autologous blood clot seal to prevent pneumothorax at CT-guided lung biopsy. Radiology. 2000;216:93–6.

    PubMed  CAS  Google Scholar 

  48. Herman SJ, Weisbrod GL. Usefulness of the blood patch technique after transthoracic needle aspiration biopsy. Radiology. 1990;176:395–7.

    PubMed  CAS  Google Scholar 

  49. Engeler CE, Hunter DW, Castaneda-Zuniga W, et al. Pneumothorax after lung biopsy: prevention with transpleural placement of compressed collagen foam plugs. Radiology. 1992;184:787–9.

    PubMed  CAS  Google Scholar 

  50. Man A, Schwarz Y, Greif J. Case report: cardiac tamponade following fine needle aspiration (FNA) of a mediastinal mass. Clin Radiol. 1998;53:151–2.

    Article  PubMed  CAS  Google Scholar 

  51. Milner LB, Ryan K, Gullo J. Fatal intrathoracic hemorrhage after percutaneous aspiration lung biopsy. AJR Am J Roentgenol. 1979;132:280–1.

    Article  PubMed  CAS  Google Scholar 

  52. Arakawa H, Nakajima Y, Kurihara H, et al. CT-guided transthoracic needle biopsy: a comparison between automated biopsy gun and fine needle aspiration. Clin Radiol. 1996;51:503–6.

    Article  PubMed  CAS  Google Scholar 

  53. Aberle DR, Gamsu G, Golden JA. Fatal systemic arterial air embolism following lung needle aspiration. Radiology. 1987;165:351–3.

    PubMed  CAS  Google Scholar 

  54. Murphy BP, Harford FJ, Cramer FS. Cerebral air embolism resulting from invasive medical procedures: treatment and hyperbaric oxygen. Ann Surg. 1985;201:242–5.

    Article  PubMed  CAS  Google Scholar 

  55. Berger RL, Dargan EL, Huang BL. Dissemination of cancer cells by needle biopsy of the lung. J Thorac Cardiovasc Surg. 1972;63:430–2.

    PubMed  CAS  Google Scholar 

  56. Khouri NF, Stitik FP, Erozan YS, et al. Transthoracic needle aspiration biopsy of benign and malignant lung lesions. AJR Am J Roentgenol. 1985;144:281–8.

    Article  PubMed  CAS  Google Scholar 

  57. Zarbo RJ, Fenoglio-Presier CM. Inter-institutional database for comparison of performance in lung fine-needle aspiration cytology: a College of American Pathologists Q-probe study of 5264 cases with histologic correlation. Arch Pathol Lab Med. 1992;116:463–70.

    PubMed  CAS  Google Scholar 

  58. Westcott JL, Najmussaqib R, Colley DP. Transthoracic needle biopsy of small pulmonary nodules. Radiology. 1997;202:97–103.

    PubMed  CAS  Google Scholar 

  59. Protopapas Z, Westcott JL. Transthoracic needle biopsy of mediastinal lymph nodes for staging lung and other cancers. Radiology. 1996;199:489–96.

    PubMed  CAS  Google Scholar 

  60. Grinan NP, Lucena FM, Romero JV, et al. Yield of percutaneous needle lung aspiration in lung abscess. Chest. 1990;97:69–74.

    Article  Google Scholar 

  61. Gruden JF, Klein JS, Webb WR. Percutaneous transthoracic needle biopsy in AIDS: analysis in 32 patients. Radiology. 1993;189:567–71.

    PubMed  CAS  Google Scholar 

  62. Scott WW, Kuhlman JE. Focal pulmonary lesions in patients with AIDS: percutaneous transthoracic needle biopsy. Radiology. 1991;180:419–21.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Antonio Gutierrez MD .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer Science+Business Media New York

About this chapter

Cite this chapter

Gutierrez, A., Abtin, F., Suh, R.D. (2014). Percutaneous Transthoracic Lung Biopsy. In: Ahrar, K., Gupta, S. (eds) Percutaneous Image-Guided Biopsy. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8217-8_11

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-8217-8_11

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-8216-1

  • Online ISBN: 978-1-4614-8217-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics