What is the role of biopsy in the diagnosis of solitary pulmonary nodules?

Updated: Aug 22, 2019
  • Author: Pujan H Patel, MD; Chief Editor: Guy W Soo Hoo, MD, MPH  more...
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A biopsy of a lung nodule should be performed to determine whether it is malignant. The risks of biopsy and the procedural approach to tissue acquisition must of course take into account the patient's bleeding diathesis and comorbidities.

Biopsy of a solitary pulmonary nodule can be performed bronchoscopically or via CT-guided transthoracic needle aspiration (TTNA).

Because the yield from bronchoscopy is only 10-20% when the nodule is less than 2 cm in diameter, bronchoscopy with transbronchial needle aspiration (TBNA) may be helpful when the lesion is either endobronchial in location or near a large airway.

Prospective data from the NELSON lung cancer screening trial indicated that the sensitivity of bronchoscopy for suspicious nodules seen on CT scan is only 8.3%. However, if an endobronchial lesion is visualized, the sensitivity increases to 81.8%. [38] TBNA may also be helpful in sampling the mediastinal nodes. Fluoroscopy or endobronchial ultrasonography (EBUS) can be used to localize the lesions during TBNA to increase the diagnostic yield to 70% or more. [39, 40, 41]

TTNA reportedly has an accuracy of 90-95% when the lesion is 2 cm or larger in diameter, although the diagnosis is less accurate (60-80%) in lesions smaller than 2 cm. [42] Confirming a specific benign diagnosis is more difficult (approximately 70% accuracy). Therefore, most benign lesions are characterized as nondiagnostic following TTNA. The rate of pneumothorax following TTNA is approximately 20%, with 2-15% of patients requiring chest tube insertion. [43]

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