Clinical Fellow, Department of Radiology, Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, MA.
Staff Radiologist, Department of Radiology, Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, MA.
Tech Vasc Interv Radiol. 2021 Sep;24(3):100770. doi: 10.1016/j.tvir.2021.100770. Epub 2021 Sep 27.
Image-guided lung needle biopsy allows for minimally invasive diagnosis of lung pathology. In the setting of suspected malignancy, the biopsy not only confirms the diagnosis but also allows for molecular profiling, a requisite for tailored systemic therapy. Needle biopsy can also characterize non-neoplastic entities such as infections not responding to treatment and other inflammatory processes. A successful and safe lung needle biopsy starts with lesion and patient selection and careful pre-procedural evaluation. Here we review the indications and contraindications, diagnostic alternatives, approach planning and sequential procedural steps with the goal of maximizing both yield and patient safety. We discuss technical tips for preventing complications such as pleural anesthesia, the saline seal, the blood patch, the banana bend, hydro dissection, and the rapid needle out/patient rollover maneuver. We also review how to manage complications, avoid non-diagnostic biopsies, and provide recommendations for post-procedural observation and imaging follow-up.
影像引导下肺针活检可微创诊断肺部病变。在疑似恶性肿瘤的情况下，活检不仅可明确诊断，还可进行分子分析，这是靶向全身治疗的必要条件。肺针活检还可明确诊断非肿瘤性疾病，如治疗无效的感染和其他炎症过程。成功、安全的肺针活检始于病变和患者选择以及仔细的术前评估。本文回顾了适应证和禁忌证、诊断替代方法、方法规划和序贯操作步骤，旨在最大程度地提高阳性率和患者安全性。我们讨论了预防并发症的技术要点，如胸膜麻醉、盐水封层、血补丁、香蕉弯、水分离和快速出针/门诊翻滚操作。还讨论了如何处理并发症、避免非诊断性活检以及为术后观察和影像学随访提供建议。
