Patients with lesions on the chest radiograph should be discussed in a multidisciplinary meeting with a respiratory physician and radiologist at a minimum.
Percutaneous transthoracic lung biopsy (PTLB) should be considered in the following:
- New or enlarging solitary nodule or mass on the chest radiograph which is not amenable to diagnosis by bronchoscopy or CT shows it is unlikely to be accessible by bronchoscopy.
- Multiple nodules in a patient not known to have malignancy or who has had a prolonged remission or more than one primary malignancy.
- Persistent focal infiltrates, either single or multiple, for which no diagnosis has been made by sputum or blood culture, serology, or bronchoscopy.
- Hilar mass following negative bronchoscopy.
Relative Contraindications to Lung Biopsy
- Abnormalities of lung function,
- Respiratory failure (including mechanical ventilation),
- Arterial and venous pulmonary hypertension,
- Coagulation abnormalities,
- The uncooperative patient.
Complications of Lung Biopsy
- Pneumothorax (20.5% of biopsies),
- Pneumothorax requiring a chest drain (3.1%),
- Haemoptysis (5.3%), and
- Death (0.15%).
References:
- Manhire A, Charig M, Clelland C, Gleeson F, Miller R, Moss H, Pointon K, Richardson C, Sawicka E; BTS. Guidelines for radiologically guided lung biopsy. Thorax. 2003 Nov;58(11):920-36. [Medline]
- The Diffuse Parenchymal Lung Disease Group of British Thoracic Society. The diagnosis, assessment and treatment of diffuse parenchymal lung disease in adults. Introduction. Thorax. 1999 Apr;54 Suppl 1:S1-14. [Medline]
Created: June 11, 2006
