Pulmonary nodule biopsy

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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. 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. 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.