CT guided thoracic biopsy is usually performed for the diagnosis of lung, pleural or mediastinal suspicious lesions. It can be performed as an outpatient where patient monitoring and complications support are available.
- Pulmonary lesion inaccessible to bronchoscopy, or in which prior bronchoscopic biopsy is nondiagnostic
- Mediastinal or pleural mass
The contraindications must be considered individually in each case. Overall, the most important contraindication are:
- poor respiratory function or reserve
- uncooperative patient
- lack of safe access
- Uncorrectable bleeding diathesis (abnormal coagulation indices)
Laboratory parameters for a safe procedure
There are widely divergent opinions about the safe values of these indices for percutaneous biopsies. The values suggested below were considered based on the literature review, whose references are cited below.
Complete blood count : Platelet > 50000/mm3 (Some institutions determine other values between 50000 -100000/mm3)2,3
Coagulation profile: Some studies showed that having a normal INR or prothrombin time is no reassurance that the patient will not bleed after the procedure.
- International normalized ratio (INR) ≤ 1.5 3
- Normal prothrombin time (PT), partial thromboplastin time (PTT)
Review the diagnostic CT and other relevant imaging first (e.g. PET/CT) to clarify the lesion that is requested to be biopsied. Consideration of the various factors, that influence suitability and degree of risk should be reviewed, including site and size of the nodule/mass and its relationship to structures that must be avoided3:
- central bronchi
- fissures (It`s important to minimize number of pleural surfaces crossed)
Remember that on cavitating lesions the needle must be target periphery.
Patient can be positioned prone, supine or laterally dependant on the location of the lesion and their respiratory function. Many of these patients will have underlying respiratory disease and may be unable to lie completely flat.
- A radiopaque grid or skin marker should be utilized to focus the optimal access point then, after preliminary images, this point is market with a pen.
- Make antisepsis and anesthesia with lidocaine as the institution's protocol.
- A skin orifice is made using a scalpel blade.
- Biopsy needle is introduced as previous planning.
- Activate biopsy gun.
- 1. Li Y, Du Y, Yang HF et-al. CT-guided percutaneous core needle biopsy for small (≤20 mm) pulmonary lesions. Clin Radiol. 2013;68 (1): e43-8. doi:10.1016/j.crad.2012.09.008 - Pubmed citation
- 2 - Sue M, Caldwell S, Dickson R et-al. Variation between centers in technique and guidelines for liver biopsy. Liver. 1996;16 (4): 267-270. Liver (abstract) - doi:10.1111/j.1600-0676.1996.tb00741.x
- 3 - Walker TG. Interventional Procedures. Lippincott Williams & Wilkins. (2012) ISBN:1931884862. Read it at Google Books - Find it at Amazon
Synonyms & Alternative Spellings
|Synonyms or Alternative Spelling||Include in Listings?|
|CT guided pleural biopsy||✗|
|CT guided mediastinal biopsy||✗|
|CT lung thoracic biopsy||✗|