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Semin intervent Radiol 2011; 28(1): 087-097
DOI: 10.1055/s-0031-1273943
© Thieme Medical Publishers

Transthoracic Needle Biopsy

Katherine R. Birchard1
  • 1Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Publication History

Publication Date:
22 March 2011 (online)

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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
    PubMedGoogle Scholar
  • 2 Westcott J L. Percutaneous catheter drainage of pleural effusion and empyema.  AJR Am J Roentgenol. 1985;  144 (6) 1189-1193
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 5 Mueller P R, vanSonnenberg E. Interventional radiology in the chest and abdomen.  N Engl J Med. 1990;  322 (19) 1364-1374
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 11 Klein J S, Zarka M A. Transthoracic needle biopsy.  Radiol Clin North Am. 2000;  38 (2) 235-266 vii
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 22 Bernardino M E. Automated biopsy devices: significance and safety.  Radiology. 1990;  176 (3) 615-616
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 24 Haaga J R. New techniques for CT-guided biopsies.  AJR Am J Roentgenol. 1979;  133 (4) 633-641
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 26 Hueftle M G, Haaga J R. Effect of suction on biopsy sample size.  AJR Am J Roentgenol. 1986;  147 (5) 1014-1016
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 38 Sinner W N. Complications of percutaneous transthoracic needle aspiration biopsy.  Acta Radiol Diagn (Stockh). 1976;  17 (6) 813-828
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 40 Arnold B W, Zwiebel W J. Percutaneous transthoracic needle biopsy complicated by air embolism.  AJR Am J Roentgenol. 2002;  178 (6) 1400-1402
    PubMedGoogle Scholar
  • 41 Muth C M, Shank E S. Gas embolism.  N Engl J Med. 2000;  342 (7) 476-482
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar

Katherine R BirchardM.D. 

Assistant Professor of Radiology, Department of Radiology CB 7510, University of North Carolina at Chapel Hill

Chapel Hill, NC 27599

Email: Birchard@med.unc.edu

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