Transthoracic Needle Biopsy

Transthoracic needle biopsy is done to evaluate

• Peripheral lung nodules or masses

• Hilar, mediastinal, and pleural abnormalities

• Undiagnosed infiltrates or pneumonias when bronchoscopy is contraindicated or nondiagnostic

When done with the use of computed tomography (CT) guidance and with a skilled cytopathologist in attendance, transthoracic needle biopsy confirms the diagnosis of cancer with approximately 90 to 95% accuracy (1, 2).

Contraindications are similar to those of thoracentesis. Additional contraindications include the following:

Absolute contraindications

• Thrombocytopenia (platelet count < 50,000 mcL [< 50 × 10⁹/L])

• Abnormal coagulation that cannot be corrected

• Bleeding diathesis

Relative contraindications

• Bullous lung disease (increases risk of pneumothorax)

• Contralateral pneumonectomy (impaired ability to tolerate a pneumothorax)

• Intractable coughing (increases risk of pneumothorax)

• Mechanical ventilation (increases risk of pneumothorax)

• Pulmonary hypertension

The procedure should be deferred if a pneumothorax cannot be tolerated such as if there is a history of contralateral pneumonectomy.

Hydatid cysts, lung abscesses, and vascular lesions should in general not be biopsied.

Transthoracic needle biopsy is usually done by an interventional radiologist, often with a cytopathologist present.

• Under sterile conditions, local anesthesia, and imaging guidance—usually CT but sometimes ultrasonography for pleural-based lesions—a biopsy needle is passed into the suspected lesion while patients hold their breath.

• Lesions are aspirated with or without saline.

• Two or 3 samples are collected for cytologic and bacteriologic processing.

After the procedure, fluoroscopy or chest x-ray is used to rule out pneumothorax and hemorrhage.

Complications include

• Pneumothorax (10 to 17%)

• Hemoptysis (1 to 10%)

• Parenchymal hemorrhage

• Air embolism

• Subcutaneous emphysema

1. 1. Lee SM, Park CM, Lee KH, Bahn YE, Kim JI, Goo JM. C-arm cone-beam CT-guided percutaneous transthoracic needle biopsy of lung nodules: clinical experience in 1108 patients. Radiology 2014;271(1):291-300. doi:10.1148/radiol.13131265

2. 2. Takeshita J, Masago K, Kato R, et al. CT-guided fine-needle aspiration and core needle biopsies of pulmonary lesions: a single-center experience with 750 biopsies in Japan. AJR Am J Roentgenol 2015;204(1):29-34. doi:10.2214/AJR.14.13151