Contents

Search

lung biopsy

Indications: bronchoscopic lung biopsy 1) sarcoidosis 2) pulmonary Langerhans cell granuloma 3) eosinophilic pneumonitis 4) lymphangioleiomyomatosis 5) pulmonary infections 6) pulmonary alveolar proteinosis 7) lymphangitic carcinomatosis 8) *drug-induced lung disease 9) hypersensitivity pneumonitis 10) pulmonary nodule* * most common reason for lung biopsy Procedure: - bronchoscopic lung biopsy - CT-guided lung biopsy * needle aspiration rather than biopsy of lymph node diagnostic according to ref [2] Complications: 1) pneumothorax - <2% bronchoscopic lung biopsy - 37% CT-guided lung biopsy, 7% require chest tube [3] - risk factors - age > 73 - pulmonary emphysema - distance from pleura to lesion >= 1.5 cm [3] 2) hemorrhage (<3%) bronchoscopic lung biopsy * bronchoscopic lung biopsy # CT-guided lung biopsy Pathology: 1) granuloma (sarcoidosis or hypersensitivity pneumonitis in the absence of mycobacterial or fungal infection) 2) specific infectious agent 3) malignancy - CT-guided lung biopsy - positive predictive value for lung cancer 99.8% [3] - negative predictive value for lung caner 74% [3] Notes: - absence of diagnostic findings on transbronchial lung biopsy does not exclude disease because of sampling errors despite multiple biopsies - open lung biopsy may be indicated.

Related

bronchoscopy

Specific

transbronchial biopsy

General

lung/mediastinal biopsy

References

  1. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 738
  2. Medical Knowledge Self Assessment Program (MKSAP) 11, 17. American College of Physicians, Philadelphia 1998, 2015
  3. Takeshita J 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 Jan; 204:29. PMID: 25539234