Guidelines for radiologically guided lung biopsy
Authors: A Manhire
Journal: Thorax (2003)

Mortality and morbidityN Operators should audit their own practice and calculate their complication rates to inform patients before consent is given.N Operators should try to achieve the lowest quoted complication rates.These should be similar to, or better than, those from the national survey: pneumothorax (20.5% of biopsies), pneumothorax requiring a chest drain (3.1%), haemoptysis (5.3%), and death (0.15%). Indications for lung biopsyN Patients with lesions on the chest radiograph should be discussed in a multidisciplinary meeting with a respiratory physician and radiologist at a minimum.[C]N Percutaneous transthoracic lung biopsy should be considered in the following [B]:N New or enlarging solitary nodule or mass on the chest radiograph which is not amenable to diagnosis by bronchoscopy or CT shows it is unlikely to be accessible by bronchoscopy.N Multiple nodules in a patient not known to have malignancy or who has had a prolonged remission or more than one primary malignancy.N Persistent focal infiltrates, either single or multiple, for which no diagnosis has been made by sputum or blood culture, serology, or bronchoscopy. N Hilar mass. [B]Contraindications to lung biopsy N There are relative contraindications to PTLB and the balance of benefit against risk for the procedure should be assessed at a multidisciplinary meeting. [C]Preoperative investigations: coagulation indices N Prothrombin time (PT), activated partial thromboplastin time (APTT), and platelet count should be checked before percutaneous lung biopsy.[C]N Oral anticoagulants should be stopped before a percutaneous lung biopsy in accordance with the published guidelines on perioperative anticoagulation.[C]N Relative contraindications include: N Platelet count ,100 000/ml N APPT ratio or PT ratio .1.4N In these situations a decision to proceed to biopsy should be made following discussion with a haematologist. [C] Preoperative investigations: pulmonary function N The balance of benefit against risk for PTLB should be assessed by a multidisciplinary team with a respiratory physician and radiologist as a minimum.[C]N All patients should have recent pulmonary function tests (spirometry) before needle biopsy.[C] N Patients with FEV 1 ,35% predicted should not undergo needle biopsy without further assessment by the multidisciplinary team. [C]Preoperative investigations: chest radiography and CT scanning N PT, APTT, platelet count, and pulmonary function tests are desirable before needle biopsy.In patients with risk factors for bleeding, PT, APTT and platelet count are required.[C]N Recent chest radiographs and CT scans and all previous radiological investigations should be reviewed to decide if a biopsy is appropriate and must be available to the radiologist at the time of the biopsy.[C]N CT should preferably be performed before bronchoscopy. [B] N Repeat imaging should be performed if there has been significant change in the patient's clinical condition, if there has been significant delay before the biopsy is performed, or if the localising CT scan at the time of the biopsy shows significant change.[C]Biopsy procedureN All patients should have a diagnostic CT scan of the chest and liver before a biopsy procedure. [B] N Specific recommendations for the choice of biopsy imaging depend on the operator but, when possible, ultrasound should be used.[B]N The decision on the type of needle used will be made by the operator and will be dependent on operator experience, available cytological support, and the position of the lesion.[B]