Solitary pulmonary nodule diagnostic study of choice: Difference between revisions
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==Overview== | ==Overview== | ||
Lung biopsy is the study of choice to diagnose pulmonary nodule. Biopsy for pulmonary nodule may be classified into 2 categories: non-surgical biopsy and surgical biopsy. Biopsy findings associated with pulmonary nodule will depend on tumor [[histology]]. Common types of lung tissue biopsy for solitary pulmonary nodule | [[Lung]] [[biopsy]] is the study of choice to [[Diagnosis|diagnose]] pulmonary nodule. [[Biopsy]] for pulmonary nodule may be [[Classification|classified]] into 2 categories: non-[[Surgery|surgical]] [[biopsy]] and [[Surgery|surgical]] [[biopsy]]. [[Biopsy]] findings associated with pulmonary nodule will depend on [[tumor]] [[histology]]. Common types of [[lung]] [[Tissue (biology)|tissue]] [[biopsy]] for solitary pulmonary nodule include conventional bronchoscopic-guided transbronchial [[biopsy]], [[Bronchoscopy|bronchoscopic]]-[[Bronchial|transbronchial]] [[Needle aspiration biopsy|needle aspiration]], endobronchial [[ultrasound]]-guided sheath [[Bronchial|transbronchial]] [[biopsy]], and endobronchial [[ultrasound]]-guided [[Bronchial|transbronchial]] [[Needle aspiration biopsy|needle aspiration]]. Common [[Indication (medicine)|indications]] for [[biopsy]] in pulmonary nodule include: high risk nodule (> 65%), intermediate risk nodule with a high risk [[patient]] profile, intermediate risk nodule with a positive [[Positron emission tomography|positron emission tomography scan]]. | ||
==Diagnostic Study of Choice== | ==Diagnostic Study of Choice== | ||
===Study of Choice=== | ===Study of Choice=== | ||
*Lung biopsy is the study of choice to diagnose pulmonary nodule. | *[[Lung]] [[biopsy]] is the study of choice to [[Diagnosis|diagnose]] pulmonary nodule. | ||
==Biopsy== | |||
Biopsy for pulmonary nodule may be classified into 2 categories:<ref name="pmid1746503">{{cite journal |vauthors=Herman M, Galanter M, Lifshutz H |title=Combined substance abuse and psychiatric disorders in homeless and domiciled patients |journal=Am J Drug Alcohol Abuse |volume=17 |issue=4 |pages=415–22 |year=1991 |pmid=1746503 |doi= |url=}}</ref> | ===Biopsy=== | ||
:*Bronchoscopy | * [[Biopsy]] for pulmonary nodule may be [[Classification|classified]] into 2 categories:<ref name="pmid1746503">{{cite journal |vauthors=Herman M, Galanter M, Lifshutz H |title=Combined substance abuse and psychiatric disorders in homeless and domiciled patients |journal=Am J Drug Alcohol Abuse |volume=17 |issue=4 |pages=415–22 |year=1991 |pmid=1746503 |doi= |url=}}</ref> | ||
:*Transthoracic needle | |||
:*Needle core biopsy | ==== '''1. Non-[[Surgery|surgical]] [[Biopsy]]''' ==== | ||
:* Wedge resection | :*[[Bronchoscopy]] | ||
:*[[Transthoracic needle aspiration]] | |||
:*Needle core [[biopsy]] | |||
==== '''2. Surgical''' ==== | |||
:*[[Wedge resection (lung)|Wedge resection]] | |||
*[[Indication (medicine)|Indications]] for [[biopsy]] in pulmonary nodule include:<ref name="pmid1746503">{{cite journal |vauthors=Herman M, Galanter M, Lifshutz H |title=Combined substance abuse and psychiatric disorders in homeless and domiciled patients |journal=Am J Drug Alcohol Abuse |volume=17 |issue=4 |pages=415–22 |year=1991 |pmid=1746503 |doi= |url=}}</ref> | |||
:*High risk nodule (> 65%) | :*High risk nodule (> 65%) | ||
:*Intermediate risk nodule, with a high risk patient profile | :*Intermediate risk nodule, with a high risk [[patient]] profile | ||
:*Intermediate risk nodule, with a positive | :*Intermediate risk nodule, with a positive [[Positron emission tomography|positron emission tomography (PET) scan]] | ||
:*Determination of tumor histologic | :*Determination of [[tumor]] [[Histology|histologic]] sub-type | ||
:*Characterization of genetic mutations | :*Characterization of [[genetic mutations]] | ||
*Contraindications for biopsy in pulmonary nodule | *[[Contraindication|Contraindications]] for [[biopsy]] in pulmonary nodule include:<ref name="pmid1746503">{{cite journal |vauthors=Herman M, Galanter M, Lifshutz H |title=Combined substance abuse and psychiatric disorders in homeless and domiciled patients |journal=Am J Drug Alcohol Abuse |volume=17 |issue=4 |pages=415–22 |year=1991 |pmid=1746503 |doi= |url=}}</ref> | ||
* | :*[[Emphysema]] | ||
:* | :*[[Bullous]] [[disease]] | ||
:* | :*[[Chronic (medical)|Chronic]] [[respiratory failure]] | ||
==Non- | *[[Complication (medicine)|Complications]] of taking [[biopsy]] in pulmonary nodule include:<ref name="pmid1746503">{{cite journal |vauthors=Herman M, Galanter M, Lifshutz H |title=Combined substance abuse and psychiatric disorders in homeless and domiciled patients |journal=Am J Drug Alcohol Abuse |volume=17 |issue=4 |pages=415–22 |year=1991 |pmid=1746503 |doi= |url=}}</ref> | ||
:*[[Pneumothorax]] | |||
:*[[Hemothorax]] For more information about surgical biopsy of pulmonary nodule, click [[solitary pulmonary nodule surgery|here]]. | |||
===Non-surgical Procedures for Taking Biopsy=== | |||
'''Bronchoscopy''' | '''Bronchoscopy''' | ||
*Common bronchoscopy biopsy techniques for pulmonary nodule | *Common [[bronchoscopy]] [[biopsy]] techniques for pulmonary nodule include:<ref name="pmid1746503">{{cite journal |vauthors=Herman M, Galanter M, Lifshutz H |title=Combined substance abuse and psychiatric disorders in homeless and domiciled patients |journal=Am J Drug Alcohol Abuse |volume=17 |issue=4 |pages=415–22 |year=1991 |pmid=1746503 |doi= |url=}}</ref><ref name="pmid15347106">{{cite journal |vauthors=Podbielski FJ, Rodriguez HE, Brown AM, Blecha MJ, Salazar MR, Connolly MM |title=Percutaneous biopsy in evaluation of lung nodules |journal=JSLS |volume=8 |issue=3 |pages=213–6 |year=2004 |pmid=15347106 |pmc=3016799 |doi= |url=}}</ref> | ||
:*Conventional bronchoscopic-guided transbronchial biopsy | |||
:*Bronchoscopic-transbronchial needle aspiration | :*Conventional bronchoscopic-guided transbronchial [[biopsy]] | ||
:*Endobronchial ultrasound-guided sheath transbronchial biopsy | :*[[Bronchoscopy|Bronchoscopic]]-[[Bronchial|transbronchial]] [[Needle aspiration biopsy|needle aspiration]] (preferred technique) | ||
:*Endobronchial ultrasound-guided transbronchial | :*Endobronchial [[ultrasound]]-guided sheath [[Bronchial|transbronchial]] [[biopsy]] | ||
:*Endobronchial [[ultrasound]]-guided [[Bronchial|transbronchial]] [[Needle aspiration biopsy|needle aspiration]] | |||
*Indications for bronchoscopy in pulmonary nodule | *[[Indication (medicine)|Indications]] for [[bronchoscopy]] in pulmonary nodule include:<ref name="pmid15347106">{{cite journal |vauthors=Podbielski FJ, Rodriguez HE, Brown AM, Blecha MJ, Salazar MR, Connolly MM |title=Percutaneous biopsy in evaluation of lung nodules |journal=JSLS |volume=8 |issue=3 |pages=213–6 |year=2004 |pmid=15347106 |pmc=3016799 |doi= |url=}}</ref> | ||
:*Central nodules | |||
* | :*Large [[Lesion|lesions]] | ||
* | :*No fitness for [[surgery]] | ||
:* | :*Nodules close to the [[patent]] [[Airway|airways]] | ||
:*Nodules close to the | :*When [[Patient|patients]] are at risk of [[Complication (medicine)|complications]] from any other [[Procedure|procedures]] of taking [[biopsy]] | ||
:* | |||
== | '''Transthoracic Needle Biopsy''' | ||
*Usually followed by [[Computed tomography|CT]] guidance | |||
*[[Indication (medicine)|Indications]] for transthoracic needle biopsy in pulmonary nodule include:<ref name="pmid15347106">{{cite journal |vauthors=Podbielski FJ, Rodriguez HE, Brown AM, Blecha MJ, Salazar MR, Connolly MM |title=Percutaneous biopsy in evaluation of lung nodules |journal=JSLS |volume=8 |issue=3 |pages=213–6 |year=2004 |pmid=15347106 |pmc=3016799 |doi= |url=}}</ref> | |||
* | :*Peripheral nodules | ||
:*Nodules close to the [[chest wall]] | |||
:*No fitness for [[surgery]] | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} |
Latest revision as of 13:28, 2 July 2019
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2]
Overview
Lung biopsy is the study of choice to diagnose pulmonary nodule. Biopsy for pulmonary nodule may be classified into 2 categories: non-surgical biopsy and surgical biopsy. Biopsy findings associated with pulmonary nodule will depend on tumor histology. Common types of lung tissue biopsy for solitary pulmonary nodule include conventional bronchoscopic-guided transbronchial biopsy, bronchoscopic-transbronchial needle aspiration, endobronchial ultrasound-guided sheath transbronchial biopsy, and endobronchial ultrasound-guided transbronchial needle aspiration. Common indications for biopsy in pulmonary nodule include: high risk nodule (> 65%), intermediate risk nodule with a high risk patient profile, intermediate risk nodule with a positive positron emission tomography scan.
Diagnostic Study of Choice
Study of Choice
Biopsy
- Biopsy for pulmonary nodule may be classified into 2 categories:[1]
1. Non-surgical Biopsy
- Bronchoscopy
- Transthoracic needle aspiration
- Needle core biopsy
2. Surgical
- Indications for biopsy in pulmonary nodule include:[1]
- High risk nodule (> 65%)
- Intermediate risk nodule, with a high risk patient profile
- Intermediate risk nodule, with a positive positron emission tomography (PET) scan
- Determination of tumor histologic sub-type
- Characterization of genetic mutations
- Contraindications for biopsy in pulmonary nodule include:[1]
- Complications of taking biopsy in pulmonary nodule include:[1]
- Pneumothorax
- Hemothorax For more information about surgical biopsy of pulmonary nodule, click here.
Non-surgical Procedures for Taking Biopsy
Bronchoscopy
- Common bronchoscopy biopsy techniques for pulmonary nodule include:[1][2]
- Conventional bronchoscopic-guided transbronchial biopsy
- Bronchoscopic-transbronchial needle aspiration (preferred technique)
- Endobronchial ultrasound-guided sheath transbronchial biopsy
- Endobronchial ultrasound-guided transbronchial needle aspiration
- Indications for bronchoscopy in pulmonary nodule include:[2]
- Central nodules
- Large lesions
- No fitness for surgery
- Nodules close to the patent airways
- When patients are at risk of complications from any other procedures of taking biopsy
Transthoracic Needle Biopsy
- Usually followed by CT guidance
- Indications for transthoracic needle biopsy in pulmonary nodule include:[2]
- Peripheral nodules
- Nodules close to the chest wall
- No fitness for surgery
References
- ↑ 1.0 1.1 1.2 1.3 1.4 Herman M, Galanter M, Lifshutz H (1991). "Combined substance abuse and psychiatric disorders in homeless and domiciled patients". Am J Drug Alcohol Abuse. 17 (4): 415–22. PMID 1746503.
- ↑ 2.0 2.1 2.2 Podbielski FJ, Rodriguez HE, Brown AM, Blecha MJ, Salazar MR, Connolly MM (2004). "Percutaneous biopsy in evaluation of lung nodules". JSLS. 8 (3): 213–6. PMC 3016799. PMID 15347106.