Percutaneous needle biopsy of the lung and its impact on patient management

Percutaneous needle biopsy (PNB) of the lung is a commonly performed procedure, mainly used for the investigation of solitary pulmonary nodules. Developments in imaging, particularly computed tomography (CT), have enable accurate preliminary assessment and targeting of lesions. Improvements in needle design ensure the provision of diagnostic samples for both cytologic and histologic assessment; and the development of immunocytochemistry and immunohistochemistry have allowed improved accuracy in diagnosis. A significant improvement in diagnostic accuracy for benign lesions has been associated with the use of cutting needles that provide cores for histologic diagnosis, in contrast to cytologic analysis from fine-needle aspiration. The complications of PNB are well recorded and have not changed significantly with the newer imaging techniques and needles. The preliminary assessment of solitary pulmonary nodules, and the pretest likelihood of malignancy, has improved using contrast-enhanced CT and positron emission tomography; the latter modality is increasingly having a major impact on the investigation of patients with suspected malignancy. The performance of PNB must always be determined on an individual case basis and when the result is likely to affect management. The complementary roles of PNB, bronchoscopic biopsy, and video-assisted thoracoscopic biopsy continue to evolve.