Transthoracic needle biopsy of thoracic or mediastinal structures uses a cutting needle to aspirate a core of tissue for histologic analysis.
Indications for 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 to Transthoracic Needle Biopsy
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.
Procedure for Transthoracic Needle Biopsy
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 of Transthoracic Needle Biopsy
Complications include
Pneumothorax (10 to 17%)
Hemoptysis (1 to 10%)
Parenchymal hemorrhage
Air embolism
Subcutaneous emphysema
Довідкові матеріали
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. 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
