Lung Biopsy

Background and indications

CT-guided percutaneous lung biopsy is the reference technique for obtaining histological diagnosis of suspicious pulmonary nodules and masses, when endoscopic techniques (bronchoscopy, EBUS) are not feasible or inconclusive. It is essential for characterizing lung lesions (primary cancer, metastasis, infectious or inflammatory lesion) and determining tumor molecular profiling to guide treatment choice.

Pre-procedure assessment

Assessment includes recent chest CT (puncture trajectory planning, evaluation of lesion size and depth), coagulation panel (PT/INR, platelets > 50,000/mm³), pulmonary function tests if emphysema or severe COPD, and verification of anticoagulant discontinuation. Emphysema, small lesion size (< 10 mm), and deep location increase pneumothorax risk.

Procedure

The patient is positioned supine, prone, or lateral depending on lesion location. Under local anesthesia, a coaxial needle (17-19G) is inserted under CT guidance via the shortest path crossing minimal aerated lung parenchyma. The biopsy needle (18-20G) is advanced into the lesion and 3-5 cores are obtained. Immediate CT check looks for pneumothorax. The procedure takes 20 to 40 minutes.

Results and scientific evidence

CT-guided percutaneous lung biopsy offers 90-95% diagnostic sensitivity for malignant lesions and 85-95% overall diagnostic yield, with higher rates for lesions > 20 mm (Huo et al., British Journal of Radiology, 2020; DOI: 10.1259/bjr.20190866). Material obtained is sufficient for molecular analysis (EGFR, ALK, PD-L1) in over 90% of cases.

Risks and complications

Pneumothorax (15-25% of cases, of which 5-10% require chest tube drainage), alveolar hemorrhage (mild hemoptysis: 5-10%, rarely significant), local pain (10-15%). Major complications (hemothorax, air embolism) are exceptional (< 0.5%). Pneumothorax risk is reduced by coaxial needle use and autologous blood patch injection in the puncture tract.

Recovery

Monitoring for 2-4 hours with control chest radiograph is performed. Without significant pneumothorax, the patient can return home. If pneumothorax requires drainage, 24-48 hour hospitalization is needed. Histological results are available within 5-10 days.

Practical information

The procedure is performed as an outpatient or short inpatient stay depending on the case. It is performed by an interventional radiologist.