How I Do It: CT-guided Percutaneous Transthoracic Lung Biopsy

Imaging of the chest for screening or evaluation of lung pathology is one of the most commonly performed radiologic studies. The identification and confirmation of persistent pulmonary nodules, masses, or consolidations on cross-sectional imaging studies warrants additional diagnostic testing to determine the exact pathologic abnormality. Diagnostic work-up may include sputum cytologic examination, thoracentesis, transbronchial aspiration, or percutaneous transthoracic lung biopsy (PTLB). Due to advances in imaging and medical technology, CT-guided core needle biopsy has largely replaced fluoroscopic-guided fine-needle aspiration in PTLB. The goals of PTLB are to accurately target lung lesions of varying sizes, morphologic characteristics, and locations while obtaining adequate samples for histologic diagnosis, microbiologic assessment, and molecular profiling of tumors. Commonly performed by general, thoracic, or interventional radiologists, PTLB must be executed with precision and efficiency to meet these objectives. Potential complications can be life-threatening and require prompt recognition and management. Therefore, all radiologists performing PTLB should be well versed in the principles, techniques, and latest developments in the field to provide safe, effective, and efficient care to their patients. At our institution, the interventional radiology team performs all PTLB procedures and are well equipped to perform CT-guided lung biopsies, adhering closely to the principles outlined in this article.