As with other organs, the lung has various routes for biopsy, including the airways or the blood vessels, as well as via a surgical excision or a needle. A biopsy that involves passing a needle through the skin and chest wall is called a "percutaneous" or "transthoracic" approach. This approach is almost always performed to target a focal lung abnormality (termed a "lesion") and not for diffuse lung disease. As such, the procedure is almost always performed using image guidance to help visualize the target. Needle biopsies can retrieve collections of individual cells, termed "aspiration," or a 1 to 2 mm thick string of tissue, termed a "core".
Lung cancer is the predominant cause of cancer-related mortality in the United States, according to data compiled by the Centers for Disease Control. The most common purpose of transthoracic needle biopsy by far is to confirm that a lesion identified on chest computed tomography (CT) is cancerous, as well as what the lesion's histologic and molecular properties are in cases where surgical removal of the lesion alone is unlikely to effect a cure. Less commonly, transthoracic biopsy is performed to do the following:
Access a thoracic lesion not located in a lung, eg, in the mediastinum, pleural surface, or chest wall
Obtaining tissue to diagnose a lung infection
Transthoracic needle biopsy for these indications is uncommon and deserves separate dedicated discussions. This activity's scope is limited to percutaneous lung lesion biopsy (PLLB) for lung cancer diagnosis and explores the relevant anatomy, indications, contraindications, preparation steps, techniques, and complications.
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