Lung Biopsy

Percutaneous biopsy of focal lung lesions, mediastinal or hilar masses, has become an essential part of staging of pulmonary and extra-thoracic tumors.
In lung carcinoma, aspiration biopsy results in a positive diagnosis in 80% to 90% of cases. If a cutting needle is used, a positive diagnosis is expected in 95% to 98% of patients unless the lesion is necrotic.
Lesion size (<1.5 cm and >5 cm) together with a benign histology negatively affect results of cutting needle biopsy.
Indications are such as diagnosis of lung and mediastinal lesions & tumor staging.
Contraindications are such as severe emphysema or unilateral pneumothorax, bleeding diathesis, uncooperative patients, positive pressure ventilation, pulmonary arterial hypertension when a central biopsy is contemplated, suspected hydatid cyst, and lesion <5 mm.
Technique, take the shortest possible path to the lesion and avoiding vital structures. when CT is used, ensure the final tip position of the needle is imaged before a biopsy is performed. After the biopsy the patient is turned so that the punctured side is lowermost to reduce ventilation of that lung and pneumothorax.
Complications such as pneumothorax, hemoptysis, bleeding, infection, failure, air embolism. there is a low incidence of death after needle biopsy of the thorax.
Postprocedural and Follow-Up Care check post-biopsy pneumothorax, ask patient to breathe quietly, keep patient resting for 2 to 3 hours, CXR at 1 hour and 3 hours post-biopsy, if hemoptysis occurs, it is important to reassure patient that it will stop.