Pitfalls in CT-guided transthoracic needle biopsy of pulmonary nodules

Successful performance of transthoracic needle biopsy of pulmonary nodules under computed tomographic (CT) guidance requires both accurate placement of the needle tip within the nodule and withdrawal of an adequate sample from the lesion. Failure to complete the biopsy procedure or to establish a definitive tissue diagnosis may be due to a number of factors. Potential pitfalls in transthoracic needle biopsy include technical factors related to the patient, CT scanning, or the biopsy needle; factors related to the size, location, or internal characteristics of the nodule or to an abnormality within adjacent parenchyma; and complications that may occur during transthoracic needle biopsy, such as pneumothorax or parenchymal hemorrhage. Awareness of how these pitfalls may be avoided or minimized should help expedite the performance of transthoracic needle biopsy and increase the likelihood of a diagnostic result.