Unifying Concepts

Indications for Lung Biopsy

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%).



  1. 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]
  2. 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

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