Transthoracic needle aspiration: the past, present and future

Transthoracic needle aspiration (TTNA) has been used to diagnose disease in the lung for many decades. Thanks to advances in technology and cytopathology, the diagnostic power, accuracy, safety, and efficacy of TTNA are constantly improving. The transition from fluoroscopy to computed tomography (CT) has yielded better visualization, and ability to enhance sophistication of tools used to biopsy. In addition, needles are being refined for obtaining better biopsy samples and increased capabilities. Because of the minimally invasive nature of TTNA, it is becoming a strong alternative to surgical intervention. In the future, these developments will continue and TTNA will become more efficient, and potentially open a door to personalized medicine. However, there are complications due to this procedure, which include pneumothorax, hemorrhage, air embolism, and others which are very rare. Probability of complication increases when patients are older, have significant past medical history, have larger lesions, and are uncooperative during procedure. Indications, contraindications, and other considerations should be contemplated before a patient is elected for TTNA.