Diagnostic strategies of lung biopsy

Todays practice of lung biopsy should always be part of a rational strategy in diagnosing localized and diffuse lung diseases of unknown aetiology. Therefore, a number of important considerations should precede any lung biopsy procedure in order to assess an overall risk-benefit analysis and to avoid unnecessary harm to the patient. In particular, this includes a careful evaluation of the subsequent questions: 1) Is an accurate diagnosis possible by less invasive methods? 2) Is adequate equipment available? 3) Is there an increased risk of major complications? 4) Will any therapeutic option be derived from the procedure? 5) Which is the most appropriate technique? Complications and diagnostic yield of different bioptic techniques are discussed by reviewing a large number of results from the current and previous literature. Finally, the pathway of a stepwise diagnostic attempt is proposed, using examples of two frequent and challenging clinical conditions: solitary pulmonary nodules and diffuse interstitial lung diseases. In both conditions, lung biopsy is an essential part of the diagnostic procedure, providing accurate diagnosis and also therapeutic implications.