What is a transthoracic needle biopsy (TNB)?

A transthoracic needle biopsy (TNB) is a method used by radiologists to remove a piece of lung tissue for examination.
A transthoracic needle biopsy (TNB) removes a piece of lung tissue for examination and to diagnose lung conditions such as lung cancer.

A transthoracic needle biopsy (TNB) is a method used by radiologists to remove a piece of lung tissue for examination. It involves inserting a long needle through the patient’s chest wall (thorax). 

TNB is also called a closed, transthoracic, or percutaneous biopsy. This procedure can be performed on an outpatient basis or during the patient’s hospital stay. 

Why is a transthoracic needle biopsy (TNB) performed?

Most often, a transthoracic needle biopsy (TNB) is performed to rule out cancer. It is usually performed after the doctor detects an abnormality on chest X-rays or a computed tomography (CT) scan. Other reasons are

  • To diagnose lung infection
  • To determine the cause of fluid collection in the lungs
  • To determine if the lung mass is benign (noncancerous) or malignant (cancerous)

When is a transthoracic biopsy avoided?

A transthoracic needle biopsy (TNB) is avoided if the patient has the following conditions:

How is a transthoracic needle biopsy (TNB) performed?

Before the procedure

  • The patient is advised not to eat anything for 6-12 hours before the test. 
  • The doctor will ask the patient to discontinue medications, such as aspirin, ibuprofen or blood thinners (warfarin), for a certain number of days before the procedure. 
  • Before a needle biopsy of the lungs, a chest X-ray or computed tomography (CT) scan may be performed to locate the exact spot.

During the procedure

  • The doctor may give the patient a sedative to make them comfortable.
  • The patient leans forward or lies down on their back on the bed.
  • The doctor may inject a local anesthetic into the chest wall.
  • The doctor makes a small incision on the chest.
  • Next, the doctor inserts the biopsy needle, attached to a syringe, into the chest. During this procedure, the doctor looks at images displayed by the computed tomography (CT) scan or special X-ray (fluoroscopy) as the needle moves forward inside the chest toward the suspicious area in the lungs.
  • Once the needle reaches the lungs, a small sample of the lungs is drawn into the syringe. The patient may feel a short quick pain or mild discomfort. They will be asked to hold their breath at this time. 
  • The needle is removed gently, and pressure is applied on the incision wound to stop the bleeding followed by bandaging the wound.
  • The procedure usually takes 30-60 minutes. 

After the procedure

  • If the patient remains stable for 30 minutes, a chest X-ray is taken after the biopsy.
  • The biopsy sample is sent to the lab for examination, which usually takes a few days.
  • If the chest X-ray does not show a complication known as pneumothorax—collection of air between the lung and chest wall—the patient can begin to eat and move around the hospital.
  • The chest X-ray is repeated after three hours to exclude a delayed pneumothorax. If the procedure has been performed on an outpatient basis, the patient can be discharged home on the same day.
  • If the patient develops pneumothorax during a transthoracic needle biopsy (TNB), they will be observed for several hours. Sometimes, a chest tube needs to be inserted to allow the draining of air from the chest.

What are the complications of a transthoracic needle biopsy (TNB)?

A computed tomography (CT)-guided transthoracic needle biopsy (TNB) is generally a safe procedure. Complications are observed more in patients aged 60-69 years, smokers and those with chronic obstructive pulmonary disease (COPD).

The possible complications of TNB are

  • pneumothorax,
  • bleeding of wound or the lungs,
  • hemoptysis (coughing of blood),
  • hemothorax (leaking of blood in the space between the lungs and chest wall) and
  • air embolism (one or more bubbles of air that block a blood vessel).

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Medically Reviewed on 7/31/2020
References
"Transthoracic Needle Biopsy (TNB)"

Medscape Medical Reference
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