Transthoracic Needle Biopsy

ABSTRACT

Transthoracic needle biopsy (TTNB) is integral in the diagnosis and treatment of many thoracic diseases, and is an important alternative to more invasive surgical procedures. Both computed tomography and ultrasound may be used as imaging guidance for TTNB, with CT being more commonly utilized. Needle choice depends mostly upon lesion characteristics and location. During the procedure, patients must be able to follow breathing instructions. Common complications of TTNB include pneumothorax and hemoptysis.

KEYWORDS

Interventional - chest - biopsy - computed tomography - cancer

REFERENCES

• 1 House A J, Thomson K R. Evaluation of a new transthoracic needle for biopsy of benign and malignant lung lesions.  AJR Am J Roentgenol. 1977;  129 (2) 215-220
• 2 Westcott J L. Percutaneous catheter drainage of pleural effusion and empyema.  AJR Am J Roentgenol. 1985;  144 (6) 1189-1193
• 3 McGahan J P, Anderson M W, Walter J P. Portable real-time sonographic and needle guidance systems for aspiration and drainage.  AJR Am J Roentgenol. 1986;  147 (6) 1241-1246
• 4 Klein J S, Schultz S, Heffner J E. Interventional radiology of the chest: image-guided percutaneous drainage of pleural effusions, lung abscess, and pneumothorax.  AJR Am J Roentgenol. 1995;  164 (3) 581-588
• 5 Mueller P R, vanSonnenberg E. Interventional radiology in the chest and abdomen.  N Engl J Med. 1990;  322 (19) 1364-1374
• 6 Ohno Y, Hatabu H, Takenaka D, Imai M, Ohbayashi C, Sugimura K. Transthoracic CT-guided biopsy with multiplanar reconstruction image improves diagnostic accuracy of solitary pulmonary nodules.  Eur J Radiol. 2004;  51 (2) 160-168
• 7 Kirchner J, Kickuth R, Laufer U, Schilling E M, Adams S, Liermann D. CT fluoroscopy-assisted puncture of thoracic and abdominal masses: a randomized trial.  Clin Radiol. 2002;  57 (3) 188-192
• 8 Tsalafoutas I A, Tsapaki V, Triantopoulou C, Gorantonaki A, Papailiou J. CT-guided interventional procedures without CT fluoroscopy assistance: patient effective dose and absorbed dose considerations.  AJR Am J Roentgenol. 2007;  188 (6) 1479-1484
• 9 Schreiber G, McCrory D C. Performance characteristics of different modalities for diagnosis of suspected lung cancer: summary of published evidence.  Chest. 2003;  123 (1, Suppl) 115S-128S
• 10 Swischuk J L, Castaneda F, Patel J C et al.. Percutaneous transthoracic needle biopsy of the lung: review of 612 lesions.  J Vasc Interv Radiol. 1998;  9 (2) 347-352
• 11 Klein J S, Zarka M A. Transthoracic needle biopsy.  Radiol Clin North Am. 2000;  38 (2) 235-266 vii
• 12 Connor S, Dyer J, Guest P. Image-guided automated needle biopsy of 106 thoracic lesions: a retrospective review of diagnostic accuracy and complication rates.  Eur Radiol. 2000;  10 (3) 490-494
• 13 Li H, Boiselle P M, Shepard J O, Trotman-Dickenson B, McLoud T C. Diagnostic accuracy and safety of CT-guided percutaneous needle aspiration biopsy of the lung: comparison of small and large pulmonary nodules.  AJR Am J Roentgenol. 1996;  167 (1) 105-109
• 14 vanSonnenberg E, Casola G, Ho M et al.. Difficult thoracic lesions: CT-guided biopsy experience in 150 cases.  Radiology. 1988;  167 (2) 457-461
• 15 Klein J S, Salomon G, Stewart E A. Transthoracic needle biopsy with a coaxially placed 20-gauge automated cutting needle: results in 122 patients.  Radiology. 1996;  198 (3) 715-720
• 16 Kucuk C U, Yilmaz A, Yilmaz A, Akkaya E. CT-guided transthoracic fine-needle aspiration in diagnosis of lung cancer: a comparison of single-pass needle and multiple pass coaxial needle systems and the value of immediate cytological assessment.  Respirology. 2004;  9 392-396
• 17 Kazerooni E A, Lim F T, Mikhail A, Martinez F J. Risk of pneumothorax in CT-guided transthoracic needle aspiration biopsy of the lung.  Radiology. 1996;  198 (2) 371-375
• 18 Solomon S B, Zakowski M F, Pao W et al.. Core needle lung biopsy specimens: adequacy for EGFR and KRAS mutational analysis.  AJR Am J Roentgenol. 2010;  194 (1) 266-269
• 19 Gong Y, Sneige N, Guo M, Hicks M E, Moran C A. Transthoracic fine-needle aspiration vs concurrent core needle biopsy in diagnosis of intrathoracic lesions: a retrospective comparison of diagnostic accuracy.  Am J Clin Pathol. 2006;  125 (3) 438-444
• 20 Andriole J G, Haaga J R, Adams R B, Nunez C. Biopsy needle characteristics assessed in the laboratory.  Radiology. 1983;  148 (3) 659-662
• 21 Arakawa H, Nakajima Y, Kurihara Y, Niimi H, Ishikawa T. CT-guided transthoracic needle biopsy: a comparison between automated biopsy gun and fine needle aspiration.  Clin Radiol. 1996;  51 (7) 503-506
• 22 Bernardino M E. Automated biopsy devices: significance and safety.  Radiology. 1990;  176 (3) 615-616
• 23 Xia Y, Chen E, Tibbits D L, Reilley T E, McSweeney T D. Comparison of effects of lidocaine hydrochloride, buffered lidocaine, diphenhydramine, and normal saline after intradermal injection.  J Clin Anesth. 2002;  14 (5) 339-343
• 24 Haaga J R. New techniques for CT-guided biopsies.  AJR Am J Roentgenol. 1979;  133 (4) 633-641
• 25 Silverman S G, Bloom D A, Seltzer S E, Tempany C M, Adams D F. Needle-tip localization during CT-guided abdominal biopsy: comparison of conventional and spiral CT.  AJR Am J Roentgenol. 1992;  159 (5) 1095-1097
• 26 Hueftle M G, Haaga J R. Effect of suction on biopsy sample size.  AJR Am J Roentgenol. 1986;  147 (5) 1014-1016
• 27 Mullan C P, Kelly B E, Ellis P K, Hughes S, Anderson N, McCluggage W G. CT-guided fine-needle aspiration of lung nodules: effect on outcome of using coaxial technique and immediate cytological evaluation.  Ulster Med J. 2004;  73 (1) 32-36
• 28 Morrissey B, Adams H, Gibbs A R, Crane M D. Percutaneous needle biopsy of the mediastinum: review of 94 procedures.  Thorax. 1993;  48 (6) 632-637
• 29 Gupta S, Seaberg K, Wallace M J et al.. Imaging-guided percutaneous biopsy of mediastinal lesions: different approaches and anatomic considerations.  Radiographics. 2005;  25 (3) 763-786 discussion 786-788
• 30 Langen H J, Klose K C, Keulers P, Adam G, Jochims M, Günther R W. Artificial widening of the mediastinum to gain access for extrapleural biopsy: clinical results.  Radiology. 1995;  196 (3) 703-706
• 31 Choi C M, Um S W, Yoo C G et al.. Incidence and risk factors of delayed pneumothorax after transthoracic needle biopsy of the lung.  Chest. 2004;  126 (5) 1516-1521
• 32 Geraghty P R, Kee S T, McFarlane G, Razavi M K, Sze D Y, Dake M D. CT-guided transthoracic needle aspiration biopsy of pulmonary nodules: needle size and pneumothorax rate.  Radiology. 2003;  229 (2) 475-481
• 33 Laurent F, Michel P, Latrabe V, Tunon de Lara M, Marthan R. Pneumothoraces and chest tube placement after CT-guided transthoracic lung biopsy using a coaxial technique: incidence and risk factors.  AJR Am J Roentgenol. 1999;  172 (4) 1049-1053
• 34 Cox J E, Chiles C, McManus C M, Aquino S L, Choplin R H. Transthoracic needle aspiration biopsy: variables that affect risk of pneumothorax.  Radiology. 1999;  212 (1) 165-168
• 35 Yamagami T, Nakamura T, Iida S, Kato T, Nishimura T. Management of pneumothorax after percutaneous CT-guided lung biopsy.  Chest. 2002;  121 1013-1015
• 36 Byrd Jr R P, Fields-Ossorio C, Roy T M. Delayed chest radiographs and the diagnosis of pneumothorax following CT-guided fine needle aspiration of pulmonary lesions.  Respir Med. 1999;  93 (6) 379-381
• 37 Berquist T H, Bailey P B, Cortese D A, Miller W E. Transthoracic needle biopsy: accuracy and complications in relation to location and type of lesion.  Mayo Clin Proc. 1980;  55 (8) 475-481
• 38 Sinner W N. Complications of percutaneous transthoracic needle aspiration biopsy.  Acta Radiol Diagn (Stockh). 1976;  17 (6) 813-828
• 39 Tomiyama N, Yasuhara Y, Nakajima Y et al.. CT-guided needle biopsy of lung lesions: a survey of severe complication based on 9783 biopsies in Japan.  Eur J Radiol. 2006;  59 (1) 60-64
• 40 Arnold B W, Zwiebel W J. Percutaneous transthoracic needle biopsy complicated by air embolism.  AJR Am J Roentgenol. 2002;  178 (6) 1400-1402
• 41 Muth C M, Shank E S. Gas embolism.  N Engl J Med. 2000;  342 (7) 476-482
• 42 Agarwal P P, Seely J M, Matzinger F R et al.. Pleural mesothelioma: sensitivity and incidence of needle track seeding after image-guided biopsy versus surgical biopsy.  Radiology. 2006;  241 (2) 589-594