Merck Manual

Please confirm that you are a health care professional

honeypot link

Transthoracic Needle Biopsy


Rebecca Dezube

, MD, MHS, Johns Hopkins University

Last full review/revision May 2021| Content last modified May 2021
Click here for Patient Education

Transthoracic needle biopsy of thoracic or mediastinal structures uses a cutting needle to aspirate a core of tissue for histologic analysis.


Transthoracic needle biopsy is done to evaluate

  • Peripheral lung nodules or masses

  • Hilar, mediastinal, and pleural abnormalities

  • Undiagnosed infiltrates or pneumonias when bronchoscopy is contraindicated or nondiagnostic

When done with the use of computed tomography (CT) guidance and with a skilled cytopathologist in attendance, transthoracic needle biopsy confirms the diagnosis of cancer with > 95% accuracy. Needle biopsy yields an accurate diagnosis in benign processes only 50 to 60% of the time.


  • Bleeding disorder or anticoagulation that cannot be corrected and platelet count <50,000/mcL (< 50 × 109/L)

  • Bullous lung disease

  • Contralateral pneumonectomy

  • Hydatid cyst

  • Intractable coughing

  • Mechanical ventilation

  • Pulmonary hypertension

  • Putrid lung abscess

  • Suspected vascular lesions


Transthoracic needle biopsy is usually done by an interventional radiologist, often with a cytopathologist present.

  • Under sterile conditions, local anesthesia, and imaging guidance—usually CT but sometimes ultrasonography for pleural-based lesions—a biopsy needle is passed into the suspected lesion while patients hold their breath.

  • Lesions are aspirated with or without saline.

  • Two or 3 samples are collected for cytologic and bacteriologic processing.

After the procedure, fluoroscopy and chest x-rays are used to rule out pneumothorax and hemorrhage.


Complications include

  • Pneumothorax (10 to 37%)

  • Hemoptysis (10 to 25%)

  • Parenchymal hemorrhage

  • Air embolism

  • Subcutaneous emphysema

Click here for Patient Education
NOTE: This is the Professional Version. CONSUMERS: Click here for the Consumer Version
Professionals also read
Test your knowledge
Which of the following populations is most at risk of asbestosis due to exposure to asbestos?
Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID

Also of Interest