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Transthoracic Needle Biopsy


Rebecca Dezube

, MD, MHS, Johns Hopkins University

Reviewed/Revised Nov 2023

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

Indications for Transthoracic Needle Biopsy

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

Contraindications to Transthoracic Needle Biopsy

Absolute contraindications

  • Thrombocytopenia (platelet count < 50,000 mcL [< 50 × 109/L])

  • Abnormal coagulation that cannot be corrected

  • Bleeding diathesis

Relative contraindications

  • Bullous lung disease (increases risk of pneumothorax)

  • Contralateral pneumonectomy (impaired ability to tolerate a pneumothorax)

  • Intractable coughing (increases risk of pneumothorax)

  • Mechanical ventilation (increases risk of pneumothorax)

  • Pulmonary hypertension

The procedure should be deferred if a pneumothorax cannot be tolerated such as if there is a history of contralateral pneumonectomy.

Hydatid cysts, lung abscesses, and vascular lesions should in general not be biopsied.

Procedure for Transthoracic Needle Biopsy

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 or chest x-ray is used to rule out pneumothorax and hemorrhage.

Complications of Transthoracic Needle Biopsy

Complications include

  • Pneumothorax (10 to 17%)

  • Hemoptysis (1 to 10%)

  • Parenchymal hemorrhage

  • Air embolism

  • Subcutaneous emphysema


  • 1. Lee SM, Park CM, Lee KH, Bahn YE, Kim JI, Goo JM. C-arm cone-beam CT-guided percutaneous transthoracic needle biopsy of lung nodules: clinical experience in 1108 patients. Radiology 2014;271(1):291-300. doi:10.1148/radiol.13131265

  • 2. Takeshita J, Masago K, Kato R, et al. CT-guided fine-needle aspiration and core needle biopsies of pulmonary lesions: a single-center experience with 750 biopsies in Japan. AJR Am J Roentgenol 2015;204(1):29-34. doi:10.2214/AJR.14.13151

NOTE: This is the Professional Version. CONSUMERS: View Consumer Version
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