Evidence-based Approach to Transthoracic Needle Biopsy: Procedural Techniques, Risks, and Controversies

Transthoracic needle biopsy (TTNB) is a well-established method of diagnostic evaluation used to answer a range of clinical questions and is an important diagnostic tool in the workup and management of patients with suspected or known malignancy or infection. Over the past decade, the body of literature on TTNB has continued to elucidate and support best practices and shed light on emerging uses of TTNB such as molecular testing. As such, TTNB should be considered when technically feasible and safe. Developing and maintaining an evidence-based approach to preprocedural evaluation, procedural technique, risks or risk mitigation, and practice-related controversies helps the radiologist optimize procedural outcomes and serve as an effective consultant to multidisciplinary teams that seek out this procedure to help guide patient care. ^©RSNA, 2025.