Percutaneous needle biopsy of the lung and its impact on patient management

Percutaneous needle biopsy (PNB) of the lung is a commonly performed proced ure, mainly used for the investigation of solitary pulmonary nodules. Devel opments in imaging, particularly computed tomography (CT), have enable accu rate preliminary assessment and targeting of lesions. Improvements in needl e design ensure the provision of diagnostic samples for both cytologic and histologic assessment; and the development of immunocytochemistry and immun ohistochemistry have allowed improved accuracy in diagnosis. A significant improvement in diagnostic accuracy for benign lesions has been associated w ith the use of cutting needles that provide cores for histologic diagnosis, in contrast to cytologic analysis from fine-needle aspiration. The complic ations of PNB are well recorded and have not changed significantly with the newer imaging techniques and needles. The preliminary assessment of solita ry pulmonary nodules, and the pretest likelihood of malignancy, has improve d using contrast-enhanced CT and positron emission tomography; the latter m odality is increasingly having a major impact on the investigation of patie nts with suspected malignancy. The performance of PNB must always be determ ined on an individual case basis and when the result is likely to affect ma nagement. The complementary roles of PNB, bronchoscopic biopsy, and video-a ssisted thoracoscopic biopsy continue to evolve.