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
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.
Contraindications are similar to those of thoracentesis. Additional contraindications include the following:
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.