Percutaneous Lung Biopsy: Technique, Efficacy, and Complications

Ronald S. Winokur; Bradley B. Pua; Brian W. Sullivan; David C. Madoff

doi:10.1055/s-0033-1342952

Seminars in Interventional Radiology, Table of Contents

Semin intervent Radiol 2013; 30(02): 121-127
DOI: 10.1055/s-0033-1342952

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Percutaneous Lung Biopsy: Technique, Efficacy, and Complications

Ronald S. Winokur

¹Division of Interventional Radiology, Weill Cornell Medical College, New York, New York

,

Bradley B. Pua

¹Division of Interventional Radiology, Weill Cornell Medical College, New York, New York

,

Brian W. Sullivan

¹Division of Interventional Radiology, Weill Cornell Medical College, New York, New York

,

David C. Madoff

¹Division of Interventional Radiology, Weill Cornell Medical College, New York, New York

› Author Affiliations

Abstract

Computed tomography–guided percutaneous needle biopsy of the lung is an indispensable tool in the evaluation of pulmonary abnormalities due to its high diagnostic accuracy in the detection of malignancy. Percutaneous biopsy in the lung plays a critical role in obtaining pathologic proof of malignancy, guiding staging and planning treatment. This article reviews biopsy techniques and their related efficacy and complications.

Keywords

interventional radiology - lung cancer - biopsy - percutaneous

Full Text

References

References
1 Beslic S, Zukic F, Milisic S. Percutaneous transthoracic CT guided biopsies of lung lesions; fine needle aspiration biopsy versus core biopsy. Radiol Oncol 2012; 46 (1) 19-22
2 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
3 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
4 Boiselle PM, Shepard JA, Mark EJ , et al. Routine addition of an automated biopsy device to fine-needle aspiration of the lung: a prospective assessment. AJR Am J Roentgenol 1997; 169 (3) 661-666
5 Haramati LB. CT-guided automated needle biopsy of the chest. AJR Am J Roentgenol 1995; 165 (1) 53-55
6 Klein JS, Salomon G, Stewart EA. Transthoracic needle biopsy with a coaxially placed 20-gauge automated cutting needle: results in 122 patients. Radiology 1996; 198 (3) 715-720
7 Goralnik CH, O'Connell DM, el Yousef SJ, Haaga JR. CT-guided cutting-needle biopsies of selected chest lesions. AJR Am J Roentgenol 1988; 151 (5) 903-907
8 Yeow K-M, Tsay P-K, Cheung Y-C, Lui K-W, Pan K-T, Chou AS-B. Factors affecting diagnostic accuracy of CT-guided coaxial cutting needle lung biopsy: retrospective analysis of 631 procedures. J Vasc Interv Radiol 2003; 14 (5) 581-588
9 Montaudon M, Latrabe V, Pariente A, Corneloup O, Begueret H, Laurent F. Factors influencing accuracy of CT-guided percutaneous biopsies of pulmonary lesions. Eur Radiol 2004; 14 (7) 1234-1240
10 Patel IJ, Davidson JC, Nikolic B , et al; Standards of Practice Committee, with Cardiovascular and Interventional Radiological Society of Europe (CIRSE) Endorsement. Consensus guidelines for periprocedural management of coagulation status and hemostasis risk in percutaneous image-guided interventions. J Vasc Interv Radiol 2012; 23 (6) 727-736
11 Kim GR, Hur J, Lee SM , et al. CT fluoroscopy-guided lung biopsy versus conventional CT-guided lung biopsy: a prospective controlled study to assess radiation doses and diagnostic performance. Eur Radiol 2011; 21 (2) 232-239
12 Heck SL, Blom P, Berstad A. Accuracy and complications in computed tomography fluoroscopy-guided needle biopsies of lung masses. Eur Radiol 2006; 16 (6) 1387-1392
13 Prosch H, Stadler A, Schilling M , et al. CT fluoroscopy-guided vs. multislice CT biopsy mode-guided lung biopsies: accuracy, complications and radiation dose. Eur J Radiol 2012; 81 (5) 1029-1033
14 Paulson EK, Sheafor DH, Enterline DS, McAdams HP, Yoshizumi TT. CT fluoroscopy—guided interventional procedures: techniques and radiation dose to radiologists. Radiology 2001; 220 (1) 161-167
15 Küçük CU, Yilmaz A, Yilmaz A, Akkaya E. Computed tomography-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 (3) 392-396
16 Lang EK, Ghavami R, Schreiner VC, Archibald S, Ramirez J. Autologous blood clot seal to prevent pneumothorax at CT-guided lung biopsy. Radiology 2000; 216 (1) 93-96
17 Wagner JM, Hinshaw JL, Lubner MG , et al. CT-guided lung biopsies: pleural blood patching reduces the rate of chest tube placement for postbiopsy pneumothorax. AJR Am J Roentgenol 2011; 197 (4) 783-788
18 Bourgouin PM, Shepard JA, McLoud TC, Spizarny DL, Dedrick CG. Transthoracic needle aspiration biopsy: evaluation of the blood patch technique. Radiology 1988; 166 (1 Pt 1) 93-95
19 Herman SJ, Weisbrod GL. Usefulness of the blood patch technique after transthoracic needle aspiration biopsy. Radiology 1990; 176 (2) 395-397
20 Yamagami T, Kato T, Hirota T, Yoshimatsu R, Matsumoto T, Nishimura T. Usefulness and limitation of manual aspiration immediately after pneumothorax complicating interventional radiological procedures with the transthoracic approach. Cardiovasc Intervent Radiol 2006; 29 (6) 1027-1033
21 Brown KT, Brody LA, Getrajdman GI, Napp TE. Outpatient treatment of iatrogenic pneumothorax after needle biopsy. Radiology 1997; 205 (1) 249-252
22 Covey AM, Gandhi R, Brody LA, Getrajdman G, Thaler HT, Brown KT. Factors associated with pneumothorax and pneumothorax requiring treatment after percutaneous lung biopsy in 443 consecutive patients. J Vasc Interv Radiol 2004; 15 (5) 479-483
23 Gupta S, Hicks ME, Wallace MJ, Ahrar K, Madoff DC, Murthy R. Outpatient management of postbiopsy pneumothorax with small-caliber chest tubes: factors affecting the need for prolonged drainage and additional interventions. Cardiovasc Intervent Radiol 2008; 31 (2) 342-348
24 Crestanello JA, Allen MS, Jett JR , et al. Thoracic surgical operations in patients enrolled in a computed tomographic screening trial. J Thorac Cardiovasc Surg 2004; 128 (2) 254-259
25 Midthun DE. Solitary pulmonary nodule: time to think small. Curr Opin Pulm Med 2000; 6 (4) 364-370
26 Allen MS, Darling GE, Pechet TT , et al; ACOSOG Z0030 Study Group. Morbidity and mortality of major pulmonary resections in patients with early-stage lung cancer: initial results of the randomized, prospective ACOSOG Z0030 trial. Ann Thorac Surg 2006; 81 (3) 1013-1019 ; discussion 1019–1020
27 Gelbman BD, Cham MD, Kim W , et al. Radiographic and clinical characterization of false negative results from CT-guided needle biopsies of lung nodules. J Thorac Oncol 2012; 7 (5) 815-820
28 Schreiber G, McCrory DC. Performance characteristics of different modalities for diagnosis of suspected lung cancer: summary of published evidence. Chest 2003; 123 (1, Suppl): 115S-128S
29 Savage C, Walser EM, Schnadig V, Woodside KJ, Ustuner E, Zwischenberger JB. Transthoracic image-guided biopsy of lung nodules: when is benign really benign?. J Vasc Interv Radiol 2004; 15 (2 Pt 1) 161-164
30 Calhoun P, Feldman PS, Armstrong P , et al. The clinical outcome of needle aspirations of the lung when cancer is not diagnosed. Ann Thorac Surg 1986; 41 (6) 592-596
31 Anderson JM, Murchison J, Patel D. CT-guided lung biopsy: factors influencing diagnostic yield and complication rate. Clin Radiol 2003; 58 (10) 791-797
32 Oikonomou A, Matzinger FR, Seely JM, Dennie CJ, Macleod PJ. Ultrathin needle (25 G) aspiration lung biopsy: diagnostic accuracy and complication rates. Eur Radiol 2004; 14 (3) 375-382
33 Tsukada H, Satou T, Iwashima A, Souma T. Diagnostic accuracy of CT-guided automated needle biopsy of lung nodules. AJR Am J Roentgenol 2000; 175 (1) 239-243
34 Laurent F, Latrabe V, Vergier B, Montaudon M, Vernejoux JM, Dubrez J. CT-guided transthoracic needle biopsy of pulmonary nodules smaller than 20 mm: results with an automated 20-gauge coaxial cutting needle. Clin Radiol 2000; 55 (4) 281-287
35 Mullan CP, Kelly BE, Ellis PK, Hughes S, Anderson N, McCluggage WG. 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
36 Khan MF, Straub R, Moghaddam SR , et al. Variables affecting the risk of pneumothorax and intrapulmonal hemorrhage in CT-guided transthoracic biopsy. Eur Radiol 2008; 18 (7) 1356-1363
37 Saji H, Nakamura H, Tsuchida T , et al. The incidence and the risk of pneumothorax and chest tube placement after percutaneous CT-guided lung biopsy: the angle of the needle trajectory is a novel predictor. Chest 2002; 121 (5) 1521-1526
38 Wu CC, Maher MM, Shepard J-AO. Complications of CT-guided percutaneous needle biopsy of the chest: prevention and management. AJR Am J Roentgenol 2011; 196 (6) W678-82
39 Yeow K-M, Su I-H, Pan K-T , et al. Risk factors of pneumothorax and bleeding: multivariate analysis of 660 CT-guided coaxial cutting needle lung biopsies. Chest 2004; 126 (3) 748-754
40 Cox JE, Chiles C, McManus CM, Aquino SL, Choplin RH. Transthoracic needle aspiration biopsy: variables that affect risk of pneumothorax. Radiology 1999; 212 (1) 165-168
41 Tanaka J, Sonomura T, Shioyama Y , et al. “Oblique path”—the optimal needle path for computed tomography-guided biopsy of small subpleural lesions. Cardiovasc Intervent Radiol 1996; 19 (5) 332-334
42 Fish GD, Stanley JH, Miller KS, Schabel SI, Sutherland SE. Postbiopsy pneumothorax: estimating the risk by chest radiography and pulmonary function tests. AJR Am J Roentgenol 1988; 150 (1) 71-74
43 Ko JP, Shepard JO, Drucker EA , et al. Factors influencing pneumothorax rate at lung biopsy: are dwell time and angle of pleural puncture contributing factors?. Radiology 2001; 218 (2) 491-496
44 Topal U, Berkman YM. Effect of needle tract bleeding on occurrence of pneumothorax after transthoracic needle biopsy. Eur J Radiol 2005; 53 (3) 495-499
45 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
46 Mirski MA, Lele AV, Fitzsimmons L, Toung TJ. Diagnosis and treatment of vascular air embolism. Anesthesiology 2007; 106 (1) 164-177
47 Ayar D, Golla B, Lee JY, Nath H. Needle-track metastasis after transthoracic needle biopsy. J Thorac Imaging 1998; 13 (1) 2-6