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.

Biopsy

Biopsy for pulmonary nodule may be classified into 2 categories:

• Non-surgical biopsy

• Bronchoscopy
• Transthoracic needle biopsy
• Needle core biopsy

• Surgical

• Wedge resection

• 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 scan (PET) scan
• Determination of tumor histologic subtype
• Characterization of genetic mutations

• Contraindications for biopsy in pulmonary nodule, include:

• Emphysema
• Bullous disease
• Chronic respiratory failure

• Complications for for biopsy in pulmonary nodule, include:

• Pneumothorax
• Hemothorax

Non-Surgical Biopsy

Bronchoscopy

• Common bronchoscopy biopsy techniques for pulmonary nodule, include:

• 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:

• 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:

• 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