Pulmonary nodule biopsy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2]

Overview

Biopsy for pulmonary nodule may be classified into 2 categories: non-surgical biopsy and surgical biopsy. Biopsy findings associated with pulmonary nodule will depend on tumor histology. Common types of lung tissue biopsy for solitary pulmonary nodule, include: conventional bronchoscopic-guided transbronchial biopsy, bronchoscopic-transbronchial needle aspiration, endobronchial ultrasound-guided sheath transbronchial biopsy, and endobronchial ultrasound-guided transbronchial needle aspiration. Common indications for biopsy in pulmonary nodule, include: high risk nodule (> 65%), intermediate risk nodule with a high risk patient profile, intermediate risk nodule with a positive positive positron emission tomography scan.^[1]^[2]

Biopsy

Biopsy for pulmonary nodule may be classified into 2 categories:^[1]

Non-surgical biopsy

Bronchoscopy
Transthoracic needle biopsy
Needle core biopsy

Surgical

Wedge resection

Indications for biopsy in pulmonary nodule, include:^[1]

High risk nodule (> 65%)
Intermediate risk nodule, with a high risk patient profile
Intermediate risk nodule, with a positive positive positron emission scan (PET) scan
Determination of tumor histologic subtype
Characterization of genetic mutations

Contraindications for biopsy in pulmonary nodule, include:^[1]

Emphysema
Bullous disease
Chronic respiratory failure

Complications for for biopsy in pulmonary nodule, include:^[1]

Pneumothorax
Hemothorax

Non-Surgical Biopsy

Bronchoscopy

Common bronchoscopy biopsy techniques for pulmonary nodule, include:^[1]^[2]

Conventional bronchoscopic-guided transbronchial biopsy
Bronchoscopic-transbronchial needle aspiration
Endobronchial ultrasound-guided sheath transbronchial biopsy
Endobronchial ultrasound-guided transbronchial needle aspiration
The preferred bronchoscopy biopsy techinque for pulmonary nodule is bronchoscopic-transbronchial needle aspiration.

Indications for bronchoscopy in pulmonary nodule, include:^[2]

Central nodules
Large lesions
No fitness for surgery
Nodules close to the patent airways
Patients were the risk of complications from any other biopsy is high

Transthoracic needle biopsy

Usually followed by CT guidance
Indications for transthoracic needle biopsy in pulmonary nodule, include:^[2]

Peripheral nodules
Nodules close to the chest wall
No fitness for surgery

Surgical Biopsy

For more information about surgical biopsy of pulmonary nodule, click here

References

↑ ^1.0 ^1.1 ^1.2 ^1.3 ^1.4 ^1.5 Herman M, Galanter M, Lifshutz H (1991). “Combined substance abuse and psychiatric disorders in homeless and domiciled patients”. Am J Drug Alcohol Abuse. 17 (4): 415–22. PMID 1746503.
↑ ^2.0 ^2.1 ^2.2 ^2.3 Podbielski FJ, Rodriguez HE, Brown AM, Blecha MJ, Salazar MR, Connolly MM (2004). “Percutaneous biopsy in evaluation of lung nodules”. JSLS. 8 (3): 213–6. PMC 3016799. PMID 15347106.

[pmid1746503-1] 1.0 ^1.1 ^1.2 ^1.3 ^1.4 ^1.5 Herman M, Galanter M, Lifshutz H (1991). “Combined substance abuse and psychiatric disorders in homeless and domiciled patients”. Am J Drug Alcohol Abuse. 17 (4): 415–22. PMID 1746503.

[pmid15347106-2] 2.0 ^2.1 ^2.2 ^2.3 Podbielski FJ, Rodriguez HE, Brown AM, Blecha MJ, Salazar MR, Connolly MM (2004). “Percutaneous biopsy in evaluation of lung nodules”. JSLS. 8 (3): 213–6. PMC 3016799. PMID 15347106.

[1]

[2]