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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%).

 

References:

  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
Last Modified: 06/11/2006