What is the role of transthoracic needle aspiration (TTNA) biopsy in the workup of secondary lung cancer?

Updated: Feb 08, 2019
  • Author: Daniel S Schwartz, MD, MBA, FACS; Chief Editor: John Geibel, MD, DSc, MSc, AGAF  more...
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Answer

Transthoracic needle aspiration (TTNA) biopsy remains the initial procedure for the diagnosis of pulmonary nodules.

A 1999 meta-analysis of 48 studies reported a pooled sensitivity for malignant lesions of 86.1% (range, 83.8-88.4%), with a pooled specificity of 98.8% (range, 98.4-99.2%). [23]  CT-guided TTNA biopsy was more sensitive than fluoroscopy-guided TTNA biopsy, though other factors are used to determine which procedure is more suitable for an individual patient. Also, aspiration biopsy needles were shown to yield better results than cutting needles.

Other authors consider bronchoscopy and TTNA biopsy to be complementary procedures and advocate their sequential use. TTNA biopsy has been reported to have a high yield for malignant nodules after an indeterminate bronchoscopy.

Pneumothorax is the most consistently reported complication of the procedure. The meta-analysis reported a pooled rate of 24.5% (range, 3.1-41.7%). The pooled rate of pneumothorax requiring chest tube drainage was 6.8% (range, 0-16.6%). Bleeding of varying severity, air embolism, myocardial infarction, and local iatrogenic spread of the tumor have also been reported following the procedure.


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