These guidelines have been developed at the request of the Standards of Care Committee of the British Thoracic Society (BTS) and with the agreement of the Royal College of Radiologists and the British Society of Interventional Radiology, and approval of the Royal College of Pathologists in respect of the pathology recommendations and the Society of Cardiothoracic Surgeons of Great Britain and Ireland.

Lung biopsy is a relatively frequently performed procedure with considerable benefit for patient management but it may, on rare occasions, result in the death of the patient. It is a multidisciplinary procedure involving respiratory physicians, surgeons, and radiologists with an interest in chest diseases.

The aim of the group was to produce formal evidence based guidelines for subsequent use by those referring patients for the procedure and for those performing it.

The areas covered by these guidelines are as follows:

• Indications

• Complications, contraindications and precautions

• Consent

• Technique

• Staffing issues

• Patient information

The following areas are not covered by these guidelines:

• Lesions of the chest wall, pleura and mediastinum

• Bronchoscopic and open lung biopsy

FORMULATION OF GUIDELINES

Validity and grading of recommendations

The criteria for assessing the levels of evidence and grading of recommendations were based on those recommended in the Scottish Intercollegiate Guidelines Network in 1995¹ using the Agency of Health Care Policy and Research model used in some other BTS guidelines (tables 1 and 2).

It should be noted that there are very few randomised trials comparing the various aspects of lung biopsy and, for that reason, more detailed systems of categorisation such as that of the Scottish Intercollegiate Guidelines Network published in 2001 were not used.²

The papers selected by searching PubMed and Medline were assessed by the members of the working group and decisions on levels of evidence for each paper were made by …