Transthoracic Needle Biopsy: How to Maximize Diagnostic Accuracy and Minimize Complications

Abstract

While the transthoracic needle biopsy (TTNB) was introduced for lung biopsy about 40 years ago, it is still mainstay of pathologic diagnosis in lung cancer, because it is relatively inexpensive and has the advantage of obtaining tissue regardless of tumorbronchus relationship. With several technological advances, clinicians can perform TTNB more safely and accurately. Utilizing ultrasound-guided biopsy for peripheral lesions contacting the pleura and rapid on-site evaluation during the procedure are expected to make up the weakness of TTNB. However, due to the inherent limitations of the percutaneous approach, the incidence of complications such as pneumothorax or bleeding are inevitably higher than those of other lung biopsy techniques. Selecting an appropriate guidance modality and optimal instruments could decrease the complication rate. Thorough understating and reflection of each biopsy modality with elaborate technique are fundamental for maximizing diagnostic accuracy and minimizing the complications.

Percutaneous Image-Guided Biopsy for a Comprehensive Hybridization Capture-Based Next-Generation Sequencing in Primary Lung Cancer: Safety, Efficacy, and Predictors of Outcome

“…Intraoperative cytopathologic evaluation has been found to improve diagnostic accuracy and yield for molecular diagnostics and to reduce needle passes in image-guided transthoracic needle aspiration. 35 , 38 At our institution, intraprocedural cytopathologic evaluation is implemented routinely in all percutaneous-guided needle biopsy. Inadequacy on intraoperative cytologic assessment was associated with lower likelihood of CHCA success compared with adequate samples ( p = 0.005).…”

Liquid Biopsy — A Novel Diagnostic Tool for Management of Early-Stage Peripheral Lung Cancer

“…Surgical biopsy usually provides sufficient tissue samples, but rarely is a method of choice due to its invasiveness. The most commonly used methods for tissue sampling are transbronchial lung biopsy and transthoracic lung biopsy (Dionisio, 2012;Vansteenkiste et al, 2014;DiBardino et al, 2015;Anzidei et al, 2017;Chung et al, 2020;Dziedzic et al, 2021).…”

“…It is possible under fluoroscopy, ultrasound or CT guidance and is the method of choice for tumours located close to the chest wall. For tumours located farther from pleura, risk of complications increases with the distance that a needle has to traverse through lung parenchyma (Chung et al, 2020). The most common complications of transthoracic biopsy are pneumothorax, bleeding, air embolism, and tumour seeding in the chest wall.…”

Cryobiopsy: A Breakthrough Strategy for Clinical Utilization of Lung Cancer Organoids

“…Due to the thickness of the bronchoscope, peripheral lung lesions are very difficult to access via general bronchoscopy. TTNB sometimes causes severe complications, such as massive hemoptysis, pneumothorax, and hemothorax [20]. With the recent introduction of thin and ultrathin bronchoscopes and radial endobronchial ultrasound (EBUS), peripheral lesions can be approached, and tissues can be safely obtained [21].…”