Updates in Percutaneous Lung Biopsy: New Indications, Techniques and Controversies

Abstract

The objective of percutaneous chest biopsy is to consistently reach the amount of tissue required to meet or exceed published diagnostic accuracy rates. Many recent publications have reevaluated the subject of chest biopsy to assess borderline or controversial indications such as very small lesions, ground-glass opacities, and cases with a past nondiagnostic percutaneous biopsy. In addition, publications have reviewed sample adequacy for the accurate determination of molecular markers. These new indications promise to expand the numbers of biopsy procedures performed by radiologists. This article discusses the current role of image-guided percutaneous lung biopsies in the management of patients with pulmonary malignancies.

Keywords

interventional radiology - percutaneous biopsy - lung malignancy - molecular markers

• References

• 1 Boiselle PM, Shepard JA, Mark EJ , et al. Routine addition of an automated biopsy device to fine-needle aspiration of the lung: a prospective assessment. AJR Am J Roentgenol 1997; 169 (3) 661-666
• 2 Gong Y, Sneige N, Guo M, Hicks ME, Moran CA. Transthoracic fine-needle aspiration vs concurrent core needle biopsy in diagnosis of intrathoracic lesions: a retrospective comparison of diagnostic accuracy. Am J Clin Pathol 2006; 125 (3) 438-444
• 3 Libby DM, Smith JP, Altorki NK, Pasmantier MW, Yankelevitz D, Henschke CI. Managing the small pulmonary nodule discovered by CT. Chest 2004; 125 (4) 1522-1529
• 4 Jae LI, June IH, Miyeon Y, Kwanseop L, Yul L, Hoon BS. Percutaneous core needle biopsy for small (≤10 mm) lung nodules: accurate diagnosis and complication rates. Diagn Interv Radiol 2012; ; June 5 (Epub ahead of print)
• 5 Bladt O, De Wever W. Additional value of CT-fluoroscopic biopsy of pulmonary lesions: a retrospective study of 69 patients. JBR-BTR 2006; 89 (6) 298-302
• 6 Yamauchi Y, Izumi Y, Nakatsuka S , et al. Diagnostic performance of percutaneous core-needle lung biopsy under CT scan fluoroscopic guidance for pulmonary lesions measuring ≤10 mm. Chest 2011; 140 (6) 1669-1670
• 7 Yamagami T, Kato T, Iida S, Hirota T, Nishimura T. Percutaneous needle biopsy for small lung nodules beneath the rib under CT scan fluoroscopic guidance with gantry tilt. Chest 2004; 126 (3) 744-747
• 8 Hwang HS, Chung MJ, Lee JW, Shin SW, Lee KS. Percutaneous transthoracic biopsy: usefulness in evaluation of small pulmonary nodules. AJR Am J Roentgenol 2010; 195 (6) W400–7
• 9 Gianfelice D, Lepanto L, Perreault P, Chartrand-Lefebvre C, Milette PC. Value of CT fluoroscopy for percutaneous biopsy procedures. J Vasc Interv Radiol 2000; 11 (7) 879-884
• 10 Froelich JJ, Ishaque N, Regn J, Saar B, Walthers EM, Klose KJ. Guidance of percutaneous pulmonary biopsies with real-time CT fluoroscopy. Eur J Radiol 2002; 42 (1) 74-79
• 11 Lee IJ, Bae YA, Kim DG , et al. Percutaneous needle aspiration biopsy (PCNAB) of lung lesions: 5 years results with focusing on repeat PCNAB. Eur J Radiol 2010; 73 (3) 551-554
• 12 Tsou MH, Tsai SF, Chan KY , et al. CT-guided needle biopsy: value of on-site cytopathologic evaluation of core specimen touch preparations. J Vasc Interv Radiol 2009; 20 (1) 71-76
• 13 Hur J, Lee HJ, Nam JE , et al. Diagnostic accuracy of CT fluoroscopy-guided needle aspiration biopsy of ground-glass opacity pulmonary lesions. AJR Am J Roentgenol 2009; 192 (3) 629-634
• 14 Yamauchi Y, Izumi Y, Nakatsuka S , et al. Diagnostic performance of percutaneous core needle lung biopsy under multi-CT fluoroscopic guidance for ground-glass opacity pulmonary lesions. Eur J Radiol 2011; 79 (2) e85-e89
• 15 Pham D, Kris MG, Riely GJ , et al. Use of cigarette-smoking history to estimate the likelihood of mutations in epidermal growth factor receptor gene exons 19 and 21 in lung adenocarcinomas. J Clin Oncol 2006; 24 (11) 1700-1704
• 16 Johnson ML, Sima CS, Chaft J , et al. Association of KRAS and EGFR mutations with survival in patients with advanced lung adenocarcinomas. Cancer 2012; ; July 18 (Epub ahead of print)
• 17 Mascaux C, Iannino N, Martin B , et al. The role of RAS oncogene in survival of patients with lung cancer: a systematic review of the literature with meta-analysis. Br J Cancer 2005; 92 (1) 131-139
• 18 Eberhard DA, Johnson BE, Amler LC , et al. Mutations in the epidermal growth factor receptor and in KRAS are predictive and prognostic indicators in patients with non-small-cell lung cancer treated with chemotherapy alone and in combination with erlotinib. J Clin Oncol 2005; 23 (25) 5900-5909
• 19 Solomon SB, Zakowski MF, Pao W , et al. Core needle lung biopsy specimens: adequacy for EGFR and KRAS mutational analysis. AJR Am J Roentgenol 2010; 194 (1) 266-269
• 20 Cheung YC, Chang JW, Hsieh JJ, Lin G, Tsai YH. Adequacy and complications of computed tomography-guided core needle biopsy on non-small cell lung cancers for epidermal growth factor receptor mutations demonstration: 18-gauge or 20-gauge biopsy needle. Lung Cancer 2010; 67 (2) 166-169
• 21 Zhuang YP, Wang HY, Shi MQ, Zhang J, Feng Y. Use of CT-guided fine needle aspiration biopsy in epidermal growth factor mutation analysis in patients with lung cancer. Acta Radiol 2011; 52 (10) 1083-1087
• 22 Otani H, Toyooka S, Soh J , et al. Detection of EGFR gene mutations using the wash fluid of CT-guided biopsy needle in NSCLC patients. J Thorac Oncol 2008; 3 (5) 472-476