A SAFE HIGH-YIELD TECHNIQUE FOR CUTTING NEEDLE-BIOPSY OF THE LUNG IN PATIENTS WITH DIFFUSE LUNG-DISEASE

The approach to the diagnosis and management of patients with diffuse infiltrative lung disease (DILD) is controversial. The results of tran sbronchial biopsy are often unsatisfactory. The role of open lung biop sy is highly variable. Percutaneous cutting needle biopsy (CNB) is not recommended because of its reported high morbidity/mortality relative to its low diagnostic yield. We report a technique for CNB with a hig h diagnostic yield and a low morbidity and no mortality in 228 patient s with DILD over the past 23 years, Methods: The salient features of t he technique for CNB are as follows: the anesthetic needle does not en ter the pleural space; a Franklin Silverman needle is inserted into th e intercostal space posteriorly at outer one-third of chest wall; the biopsy is pet-formed with the breath held at normal end expiration; th e plane of pleural space is broken with sudden insertion of needle 8 t o 15 cm into lung; and the pathway of the needle is maintained paralle l to the lateral chest wall. Results: A diagnosis was established in 1 29 of 145 biopsies (89%) performed by a trained operator (A.H.N.). The re were 36 pneumothoraces (25%), four minimal hemoptyses (3%), and two chest tube placements (1%). There were no deaths (0%). Conclusion: Wi th meticulous attention to technique and careful selection of patients , the procedure offers a relatively safe alternative to open lung or t horacoscopic lung biopsy in patients with DILD.