Transthoracic needle biopsy of thoracic or mediastinal structures uses a cutting needle to aspirate a core of tissue for histologic analysis.
Indications
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.
Contraindications
Contraindications are similar to those of thoracentesis How To Do Thoracentesis Thoracentesis is needle aspiration of fluid from a pleural effusion. Thoracentesis may be done for diagnosis and/or therapy. Diagnostic thoracentesis Indicated for almost all patients who have... read more 
. Additional contraindications include the following:
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
Procedure
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
Complications include
Pneumothorax (10 to 37%)
Hemoptysis (10 to 25%)
Parenchymal hemorrhage
Air embolism
Subcutaneous emphysema
