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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%).


Related Criteria

Light Criteria for Exudative Pleural Effusion

GINA Classification of Asthma Severity

GOLD Staging System for Chronic Obstructive Lung Disease (COPD) Severity

ATS/ERS Criteria for Diagnosis of Idiopathic Pulmonary Fibrosis (IPF) in Absence of Surgical Lung Biopsy




  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]

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Created: June 11, 2006
Last Modified: 10/23/2010

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