SPECIAL TECHNIQUES IN TRANSTHORACIC NEEDLE BIOPSY OF PULMONARY NODULES
Section snippets
NEEDLE PLACEMENT
One cannot achieve accurate results from TNB if the tip of the needle is not placed within the nodule. Needle misplacement probably represents the single most common cause for a false-negative biopsy.7 Even missing the nodule by a fraction of a millimeter is not sufficient, especially when entertaining the idea of accepting a nonspecific benign diagnosis as truly representative of a benign lesion. Each aspect in the performance of the procedure can lead to difficulties with placement of the
CYTOLOGIC EVALUATION
As with the biopsy procedure itself, there are several cytologic techniques that help maximize the yield from the specimen provided. The goal of the radiologist performing TNB of pulmonary nodules is to obtain diagnostic samples. These samples are then examined microscopically to detect the presence of a neoplastic or infectious process. Excluding geometric miscalculation, the diagnostic sensitivity and specificity of TNB depends on several factors, including the quality of the specimen
COMPLICATIONS
Once the procedure has been performed and the specimen obtained, our remaining goal is to minimize complications. To accomplish this final goal effectively, potential complications should be considered before the procedure.4 The two most common complications of TNB are hemorrhage and pneumothorax. We focus on methods to reduce pneumothorax, because bleeding is primarily related to factors intrinsic to the patient or because of medications.
The rate of pneumothorax has been variously reported to
SUMMARY
We believe that each aspect of the performance of TNB needs to be considered carefully. Meticulous attention to detail allows any nodule in the chest to successfully undergo biopsy. There are techniques of needle tip repositioning that can be quite helpful for obtaining diagnostic material from lung lesions, particularly small nodules. A strong working relationship with pathologists experienced in lung cytology is a vital element of any successful biopsy program. Techniques available to the
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Cited by (50)
Multimodality imaging assessment of pulmonary nodules
2011, PET ClinicsCitation Excerpt :Some investigators26 have reported a potential value of neural networks to accurately classify lung nodules as malignant. Image-guided transthoracic needle aspiration or biopsy may help to obtain the correct diagnosis for indeterminate pulmonary nodules in high-risk patients,130 and has been shown to affect the management of indeterminate nodules ∼50% of the time.131 Image guidance can be achieved with CT, fluoroscopy, or ultrasonography.
Feasibility of CT-guided large-bore biopsy of lung tumors with the use of an outer sheath
2011, Journal of Vascular and Interventional RadiologyTreating iatrogenic pneumothorax with small-bore chest tube
2009, RadiologiaTransthoracic needle biopsy for diagnosis of lung cancer
2023, Journal of the Korean Medical AssociationAccuracy of Metabolic Imaging-guided Transthoracic Biopsy in Lung Cancer
2022, Journal of the College of Physicians and Surgeons PakistanPercutaneous Transthoracic Lung Biopsy: Optimizing Yield and Mitigating Risk
2021, Journal of Computer Assisted Tomography
Address reprint requests to David F. Yankelevitz, MD, Department of Radiology, The New York Presbyterian Hospital, Weil Medical College of Cornell University, 525 East 68th Street, New York, NY 10021