Introduction
Clinical indication
Indications for imaging-guided chest biopsy |
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1. A new or enlarging solitary nodule or mass |
2. Multiple nodules in a patient without known neoplastic disease or in prolonged remission |
3. Focal parechymal infiltrates in which an infectious organism cannot be isolated |
4. Diagnosis of hilar masses following negative broncoscopy |
5. Undiagnosed mediastinal mass. |
6. Bipopsy or re-biopsy of malignancy for targeted therapy. |
A new or enlarging solitary nodule or mass
Multiple nodules in a patient without known neoplastic disease or in prolonged remission
Focal parenchymal infiltrates in which an infectious organism cannot be isolated
Diagnosis of hilar masses following negative bronchoscopy
Undiagnosed mediastinal mass
Biopsy or re-biopsy of malignancy for targeted therapy
Contraindications
Patient management before procedures with moderate risk of bleeding | |
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INR | Correct to <1.5 |
aPTT | Should be corrected for values >1.5 × control |
Plateles | Transfusion recommended for count <50.000/μl |
Imaging guidance techniques
Biopsy procedure
Patient positioning and instruction
Access site
Breath-hold techniques and needle manipulation
Needle types
Diagnostic accuracy
Ultrasound versus CT
Accuracy | Sensitivity | Specificity | ||
---|---|---|---|---|
Imaging guidance techniqueE | Ultrasound-guide biopsy | 88.7% | 91.5% | 100% |
CT-guide biopsy | 92.1% | 92.1% | 100% | |
Biopsy technique | FNAB | 64–97% | 82–99% | 86–100% |
Core biopsy | 93% | 89% | 97% | |
Lesion location | Paramediastinal | 95.4% | 95.6% | 100% |
Peripheral | 94.7% | 94.2% | 100% |
PTX | Haemorrhage | |
---|---|---|
CT-guided biopsy | 20.5% | 2.8% |
Ultrasound-guided biopsy | 4.4% | – |
Fluoroscopy-guided biopsy | 11.1% | – |