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Semin Respir Crit Care Med 2008; 29(4): 323-334
DOI: 10.1055/s-2008-1081277
© Thieme Medical Publishers

Percutaneous Lung Biopsy: An Ordering Clinician's Guide to Current Practice

Elizabeth H. Moore1
  • 1Department of Radiology, University of California Davis School of Medicine, University of California Davis Medical Center, Sacramento, California
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Publication History

Publication Date:
23 July 2008 (online)

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ABSTRACT

The discovery of a pulmonary nodule or mass usually leads to a clinical assessment of patient risk factors for malignancy and an imaging workup. The latter may include appropriately timed follow-up, computed tomography with the possible addition of a computed tomographic nodule enhancement study, positron emission tomography, and/or percutaneous biopsy of the lung lesion or associated lymph nodes or metastatic lesions. This article reviews the rationale for the imaging workup of lung lesions and the details of percutaneous needle biopsy, including risks, technical feasibility, techniques, needle systems, cytological/pathological evaluation, accuracy, complications, and complication management.

KEYWORDS

Lung biopsy - complications - techniques

REFERENCES

  • 1 Lillington G A. Management of solitary pulmonary nodules.  Dis Mon. 1991;  37 271-318
    PubMedGoogle Scholar
  • 2 Cummings S R, Lillington G A, Richard R J. Estimating the probability of malignancy in solitary pulmonary nodules: a Bayesian approach.  Am Rev Respir Dis. 1986;  134 449-454
    PubMedGoogle Scholar
  • 3 Swensen S J, Silverstein M D, Ilstrup D M et al.. The probability of malignancy in solitary pulmonary nodules: application to small radiologically indeterminate nodules.  Arch Intern Med. 1997;  157 849-855
    CrossrefPubMedGoogle Scholar
  • 4 Libby D M, Smith J P, Altorki N K et al.. Managing the small pulmonary nodule discovered by CT.  Chest. 2004;  125 1522-1529
    CrossrefPubMedGoogle Scholar
  • 5 Wahidi M M, Govert J A, Goudar R K et al.. Evidence for the treatment of patients with pulmonary nodules: when is it lung cancer? ACCP evidence-based clinical practice guidelines (2nd edition).  Chest. 2007;  132(3, Suppl) 94S-107S
    CrossrefPubMedGoogle Scholar
  • 6 Swensen S J, Viggiano R W, Midthun D E et al.. Lung nodule enhancement at CT: multicenter study.  Radiology. 2000;  214 73-80
    CrossrefPubMedGoogle Scholar
  • 7 Bach P B, Kattan M Q, Thornquist M D et al.. Variations in lung cancer risk among smokers.  J Natl Cancer Inst. 2003;  95 470-478
    CrossrefPubMedGoogle Scholar
  • 8 Gould M K, Sanders G D, Barnett P G et al.. Cost-effectiveness of alternative management strategies for patients with solitary pulmonary nodules.  Ann Intern Med. 2003;  138 724-735
    PubMedGoogle Scholar
  • 9 Mery C M, Pappas A N, Bueno R et al.. Relationship between a history on antecedent cancer and the probability of malignancy for a solitary pulmonary nodule.  Chest. 2004;  125 2175-2181
    CrossrefPubMedGoogle Scholar
  • 10 MacMahon H, Austin J H, Gamsu G Fleischner Society et al. Guidelines for Management of Small Pulmonary Nodules Detected on CT Scans: a statement from the Fleischner Society.  Radiology. 2005;  237 395-400
    CrossrefPubMedGoogle Scholar
  • 11 Leef J L, Klein J S. The solitary pulmonary nodule.  Radiol Clin North Am. 2002;  40 123-143
    CrossrefPubMedGoogle Scholar
  • 12 Revel M P, Merlin A, Peyrard S et al.. Software volumetric evaluation of doubling times for differentiating benign versus malignant pulmonary nodules.  AJR Am J Roentgenol. 2006;  187 135-142
    CrossrefPubMedGoogle Scholar
  • 13 Gould M K, Maclean C C, Kushner W G et al.. Accuracy of positron emission tomography for diagnosis of pulmonary nodules and mass lesions: a meta-analysis.  JAMA. 2001;  285 914-924
    CrossrefPubMedGoogle Scholar
  • 14 Marom E M, Sarvis S, Herndon J E et al.. T1 lung cancers: sensitivity of diagnosis with fluorodeoxyglucose PET.  Radiology. 2002;  223 453-459
    CrossrefPubMedGoogle Scholar
  • 15 Antoch G, Stattaus J, Nemat A T et al.. Non-small cell lung cancer: dual-modality PET/CT in preoperative staging.  Radiology. 2003;  229 526-533
    CrossrefPubMedGoogle Scholar
  • 16 Ho C L. Clinical PET imaging: an Asian perspective.  Ann Acad Med Singapore. 2004;  33 155-165
    PubMedGoogle Scholar
  • 17 Christensen J A, Nathan M A, Mullan B P et al.. Characterization of the solitary pulmonary nodule: 18F-FDG PET versus nodule-enhancement CT.  AJR Am J Roentgenol. 2006;  187 1361-1367
    CrossrefPubMedGoogle Scholar
  • 18 Toloza E M, Harpole L, McCrory D C. Noninvasive staging of non-small cell lung cancer: a review of the current evidence.  Chest. 2003;  123(1, Suppl) 137S-146S
    CrossrefPubMedGoogle Scholar
  • 19 De Wever W, Ceyssens S, Mortelmans L et al.. Additional value of PET-CT in the staging of lung cancer: comparison with CT alone, PET alone and visual correlation of PET and CT.  Eur Radiol. 2007;  17 23-32
    CrossrefPubMedGoogle Scholar
  • 20 Silvestri G A, Gould M K, Margolis M L et al.. Noninvasive staging of non-small cell lung cancer: ACCP evidenced-based clinical practice guidelines (2nd edition).  Chest. 2007;  132(3, Suppl) 178S-201S
    CrossrefPubMedGoogle Scholar
  • 21 De Wever W, Vankan Y, Stroobants S, Verschakelen J. Detection of extrapulmonary lesions with integrated PET/CT in the staging of lung cancer.  Eur Respir J. 2007;  29 995-1002
    CrossrefPubMedGoogle Scholar
  • 22 Yankelevitz D F, Henschke C I, Altorki N K. Cost analysis of competing strategies for evaluating and treating solitary pulmonary nodules (abstr).  Radiology. 1996;  201 269(Suppl)
    PubMedGoogle Scholar
  • 23 Cox J E, Chiles C, McManus C M et al.. Transthoracic needle aspiration biopsy: variables that affect risk of pneumothorax.  Radiology. 1999;  212 165-168
    CrossrefPubMedGoogle Scholar
  • 24 Topal U, Ediz B. Transthoracic needle biopsy: factors affecting risk of pneumothorax.  Eur J Radiol. 2003;  48 263-267
    CrossrefPubMedGoogle Scholar
  • 25 Miller J A, Pramanik B K, Lavenhar M A. Predicting the rates of success and complications of computed tomography-guided percutaneous core-needle 45: biopsies of the thorax from the findings of the preprocedure chest computed tomography scan.  J Thorac Imaging. 1998;  13 7-13
    PubMedGoogle Scholar
  • 26 Laurent F, Michel P, Latrabe V et al.. Pneumothoraces and chest tube placement after CT-guided transthoracic lung biopsy using a coaxial technique: incidence and risk factors.  AJR Am J Roentgenol. 1999;  172 1049-1053
    PubMedGoogle Scholar
  • 27 Kazerooni E A, Lim F T, Martinez F J. Risk of pneumothorax in CT guided transthoracic needle aspiration of the lung.  Radiology. 1996;  198 371-375
    CrossrefPubMedGoogle Scholar
  • 28 Fish G D, Stanley J H, Miller K S et al.. Postbiopsy pneumothorax: estimating the risk by chest radiography and pulmonary function tests.  AJR Am J Roentgenol. 1988;  150 71-74
    PubMedGoogle Scholar
  • 29 Miller K S, Fish G B, Stanley J H. Prediction of pneumothorax rate in percutaneous needle aspiration of the lung.  Chest. 1988;  93 742-745
    CrossrefPubMedGoogle Scholar
  • 30 Haramati L B, Austin J H. Complications after CT-guided needle biopsy through aerated versus nonaerated lung.  Radiology. 1991;  181 778
    CrossrefPubMedGoogle Scholar
  • 31 Tomiyama N, Yasuhara Y, Nakajima Y et al.. CT-guided needle biopsy of lung lesions: a survey of severe complication based on 9783 biopsies in Japan.  Eur J Radiol. 2006;  59 60-64 , Epub 2006 Mar 10
    CrossrefPubMedGoogle Scholar
  • 32 Loubeyre P, Copercini M, Dietrich P Y. Percutaneous CT-guided multisampling core needle biopsy of thoracic lesions.  AJR Am J Roentgenol. 2005;  185 1294-1298
    CrossrefPubMedGoogle Scholar
  • 33 Lucidarme O, Howarth N, Finet J F, Grenier P A. Intrapulmonary lesions: percutaneous automated biopsy with a detachable, 18-gauge, coaxial cutting needle.  Radiology. 1998;  207 759-765
    CrossrefPubMedGoogle Scholar
  • 34 Klein J S, Salomon G, Stewart E A. Transthoracic needle biopsy with a coaxially placed 20-gauge automated cutting needle: results in 122 patients.  Radiology. 1996;  198 715-720
    CrossrefPubMedGoogle Scholar
  • 35 Yeow K M, Su I H, Pan K T et al.. Risk factors of pneumothorax and bleeding: multivariate analysis of 660 CT-guided coaxial cutting needle lung biopsies.  Chest. 2004;  126 748-754
    CrossrefPubMedGoogle Scholar
  • 36 Kim J H, Kim Y T, Lim H K, Kim Y H, Sung S W. Management for chest wall implantation of non-small cell lung cancer after fine-needle aspiration biopsy.  Eur J Cardiothorac Surg. 2003;  23 828-832
    CrossrefPubMedGoogle Scholar
  • 37 Yankelevitz D F, Davis S D, Chiarella D, Henschke C I. 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;  11 279-282
    PubMedGoogle Scholar
  • 38 Moore E H, Shelton D K, Wisner E R, Richardson M L, Bishop D M, Brock J M. Needle aspiration lung biopsy: reevaluation of the blood patch technique in an equine model.  Radiology. 1995;  196 183-186
    PubMedGoogle Scholar
  • 39 Moore E H. Percutaneous biopsy in lung cancer.  Semin Roentgenol. 2005;  40 154-170
    CrossrefPubMedGoogle Scholar
  • 40 Tanaka J, Sonomura T, Shioyama Y et al.. “Oblique path”: the optimal needle path for computed tomography-guided biopsy of small subpleural lesions.  Cardiovasc Intervent Radiol. 1996;  19 332-334
    PubMedGoogle Scholar
  • 41 Li H, Boiselle P, Shepard J O et al.. 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;  167 105-109
    PubMedGoogle Scholar
  • 42 Yeow K M, Tsay P K, Cheung Y C et al.. Factors affecting diagnostic accuracy of CT-guided coaxial cutting needle lung biopsy: retrospective analysis of 631 procedures.  J Vasc Interv Radiol. 2003;  14 581-588
    CrossrefPubMedGoogle Scholar
  • 43 Wallace M J, Krishnamurthy S, Broemeling L D et al.. CT-guided percutaneous fine-needle aspiration biopsy of small (< or = 1 cm) pulmonary lesions.  Radiology. 2002;  225 823-828
    PubMedGoogle Scholar
  • 44 Montaudon M, Latrabe V, Pariente A, Corneloup O, Begueret H, Laurent F. Factors influencing accuracy of CT-guided percutaneous biopsies of pulmonary lesions.  Eur Radiol. 2004;  14 1234-1240
    PubMedGoogle Scholar
  • 45 Layfield L J, Liu K, Erasmus J J. Radiologically-determined diameter, pathologic diameter, and reactive zone surrounding pulmonary neoplasms: Implications for transthoracic fine-needle aspiration of pulmonary neoplasms.  Diagn Cytopathol. 1999;  21 250-252
    CrossrefPubMedGoogle Scholar
  • 46 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;  169 661-666
    CrossrefPubMedGoogle Scholar
  • 47 Laurent F, Latrabe V, Vergier B, Michel P. Percutaneous CT-guided biopsy of the lung: comparison between aspiration and automated cutting needles using a coaxial technique.  Cardiovasc Intervent Radiol. 2000;  23 266-272
    CrossrefPubMedGoogle Scholar
  • 48 Aviram G, Greif J, Man A. Diagnosis of intrathoracic lesions: are sequential fine-needle aspiration (FNA) and core needle biopsy (CNB) better than either investigation alone?.  Clin Radiol. 2007;  62 221-226
    CrossrefPubMedGoogle Scholar
  • 49 Rivera M P, Mehta A C. American College of Chest Physicians . Initial diagnosis of lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition).  Chest. 2007;  132(3, Suppl) 131S-148S
    CrossrefPubMedGoogle Scholar
  • 50 Savage C, Walser E M, Schnadig V, Woodside K J, Ustuner E, Swischenberger J B. Transthoracic image-guided biopsy of lung nodules: when is benign really benign?.  J Vasc Interv Radiol. 2004;  15(2 Pt 1) 161-164
    CrossrefPubMedGoogle Scholar
  • 51 Quint L E, Kretschmer M, Chang A, Nan B. CT-guided thoracic core biopsies: value of a negative result.  Cancer Imaging. 2006;  6 163-167
    CrossrefPubMedGoogle Scholar
  • 52 Giaccone G, Rodriguez J A. EGFR inhibitors: what have we learned from the treatment of lung cancer?.  Nat Clin Pract Oncol. 2005;  2 554-561
    CrossrefPubMedGoogle Scholar
  • 53 Bepler G. Phase II pharmacogenomics-based adjuvant therapy trial in patients with non-small-cell lung cancer: Southwest Oncology Group Trial 0720.  Clin Lung Cancer. 2007;  8 509-511
    PubMedGoogle Scholar
  • 54 Moore E H. Technical aspects of needle aspiration lung biopsy: a personal perspective.  Radiology. 1998;  208 303-318
    CrossrefPubMedGoogle Scholar
  • 55 Lang E K, Ghavami R, Schreiner V C et al.. Autologous blood clot seat to prevent pneumothorax at CT-guided lung biopsy.  Radiology. 2000;  216 93-96
    CrossrefPubMedGoogle Scholar
  • 56 Moore E H, LeBlanc J, Montesi S A, Richardson M L, Shepard J A, McLoud T C. Effect of patient positioning after needle aspiration lung biopsy.  Radiology. 1991;  181 385-387
    PubMedGoogle Scholar
  • 57 Yankelevitz D F, Davis S D, Henschke C I. Aspiration of a large pneumothorax resulting from transthoracic needle biopsy.  Radiology. 1996;  200 695-697
    PubMedGoogle Scholar
  • 58 Perlmutt L M, Braun S D, Newman G E. Transthoracic needle aspiration: use of a small chest tube to treat pneumothorax.  AJR Am J Roentgenol. 1987;  148 849-851
    PubMedGoogle Scholar
  • 59 Lattin Jr G, O'Brien Sr W, McCrary B, Kearney P, Gover D. Massive systemic air embolism treated with hyperbaric oxygen therapy following CT-guided transthoracic needle biopsy of a pulmonary nodule.  J Vasc Interv Radiol. 2006;  17 1355-1358
    CrossrefPubMedGoogle Scholar

Elizabeth H MooreM.D. 

Department of Radiology, University of California Davis School of Medicine, University of California Davis Medical Center

4860 Y St., Ste. 3100, Sacramento, CA 95817

Email: elizabeth.moore@ucdmc.ucdavis.edu