🫁 What is percutaneous lung biopsy?
CT-guided percutaneous lung biopsy involves taking one or more tissue samples from a chest lesion (lung, pleura, mediastinum, chest wall) using a needle inserted through the skin and ribs, under real-time CT guidance. The sample is then analysed in the pathology laboratory to establish a precise histological and/or molecular diagnosis, essential for the treatment decision.
Percutaneous biopsy avoids surgery (thoracoscopy, mediastinoscopy) with its anaesthetic risks and recovery time. It provides a histological diagnosis précis en ambulatoire ou après une courte hospitalisation, et peut être répétée si nécessaire.
✅ What are the expected benefits?
- Precise histological and/or molecular diagnosis, essential for the treatment decision
- Diagnostic sample rate above 90% for lesions larger than 2 cm
- Évite une thoracoscopie ou médiastinoscopie chirurgicale et ses risques anesthésiques
- Allows molecular biology sampling (EGFR, ALK, ROS1, PD-L1 mutations) essential for targeted therapies
- Performed as an outpatient or after a short hospital stay
🎯 In which situations?
- Suspicious lung mass of undetermined nature on CT (primary tumour, metastasis)
- Lung nodule at high risk of malignancy (growth, suspicious features on PET scan)
- Recurrent pleural effusion or suspicious pleural mass (mesothelioma, pleural metastasis)
- Mediastinal mass (lymphoma, germ cell tumour, thymoma, lymphadenopathy)
- Chest wall lesion (primary tumour, wall invasion)
- Staging of a known tumour: histological confirmation of recurrence or metastases
- Molecular biology sampling: EGFR, ALK, ROS1, PD-L1 mutations — essential for targeted therapies
📋 Essential pre-procedure work-up
- Recent contrast-enhanced chest CT (less than 4 weeks old) — essential for guidance
- PET scan if available (characterisation and targeting of the most active area)
- Strict coagulation work-up: PT, aPTT, platelets — must be normal before the procedure
- Recent pulmonary function tests if low FEV1 or known respiratory disease
- Stopping anticoagulants and antiplatelets per protocol (check with the prescriber)
- Blood group + antibody screen if biopsy of a highly vascular lesion
🔬 How the biopsy is performed
Positioning and CT planning — Position adapted to the location of the lesion (supine, prone or lateral). A CT acquisition is performed to plan the optimal needle path precisely.
Local anaesthesia — Skin and subcutaneous infiltration with 2% lidocaine. You remain conscious and can communicate with the team.
Real-time CT guidance — The needle is advanced gradually under CT control. Short breath-holds (3 to 5 seconds) are requested to freeze respiratory movement at the moment of sampling.
Sampling — Semi-automatic biopsy needle (Tru-Cut® 18G). 3 to 6 tissue cores are taken depending on the size and nature of the lesion. Additional samples for cytology or molecular biology may be obtained.
Immediate control CT — A routine post-biopsy acquisition to check for pneumothorax or haemothorax before removing the needle.
4-hour monitoring — In the recovery room or outpatient unit. A control chest X-ray is performed before discharge. The procedure lasts 30 to 60 minutes in total.
⚠️ Complications — what you need to know
🔶 Pneumothorax (15–25%)
The most common complication. In most cases it is small and resolves spontaneously. Chest drainage (aspiration or drain) is needed in 5–10% of cases. If large: admission to the respiratory ward.
🔴 Haemoptysis (5–10%)
Coughing up blood, usually minor and transient. Heavy haemoptysis is rare. Tell the team immediately if it occurs.
🟣 Haemothorax (< 1%)
Bleeding into the pleural cavity. Rare, requiring prolonged in-hospital monitoring.
✅ Needle-track seeding (< 0.1%)
Theoretical risk of tumour spread along the needle track — exceptional with current techniques. Track cauterisation on withdrawal if indicated.
The frequencies shown are estimates from the literature and may vary depending on the situations individuelles.
📐 What are the limits of this examination?
- Le pneumothorax (15-25 %) est la complication la plus fréquente, le plus souvent sans conséquence
- Les lésions de moins de 2 cm ou de localisation difficile (proche des gros vaisseaux, du cœur) peuvent être moins accessibles
- The sample may be non-diagnostic in some cases, requiring a repeat biopsy
- Les résultats de biologie moléculaire nécessitent 3 à 4 semaines
🔀 What other diagnostic approaches are possible?
🔬 Endoscopie bronchique
For central or endobronchial lesions, bronchoscopic biopsy is an alternative to the percutaneous route.
🏥 Thoracoscopie / médiastinoscopie chirurgicale
Allows a larger sample but requires general anaesthesia and hospital admission.
👁️ Imaging surveillance
For small, low-risk nodules, CT surveillance may be offered.
❔ What if I decide not to have the biopsy?
You remain entirely free in your decision. The absence of a histological diagnosis may delay treatment. Your doctor will discuss the alternatives with you: bronchoscopy, surgical biopsy, or imaging surveillance depending on your situation.
🏠 Aftercare and results
- Discharge the same day if there is no significant pneumothorax and good tolerance
- One night in the respiratory ward if moderate pneumothorax or fragile respiratory status
- Pathology result within 7 to 10 working days
- Molecular biology result (EGFR, ALK, PD-L1 mutations…) within 3 to 4 weeks depending on the tests requested
- The result will be communicated to you by the referring doctor
Frequently asked questions
What is the risk of pneumothorax?
Is the biopsy performed under general anaesthesia?
Can I drive after the procedure?
📄 Book an appointment
Requests for percutaneous lung biopsy are sent to our interventional radiology secretariat:
- 📧 Isabelle.parrain@aphp.fr (secretary dedicated exclusively to lung biopsies · external patients accepted · admission to the respiratory ward)
- ✉ ️ ri.cch@aphp.fr (general IR secretariat)
- 📞 01 58 41 46 12 (lun–ven 8h30–17h30)
Documents à joindre à la demande :
- Lettre de demande du médecin prescripteur avec indication clinique
- CD-ROM or PACS access to the recent chest CT
- Résultats du bilan de coagulation
- Liste des traitements anticoagulants/antiagrégants en cours
- EFR récentes si disponibles
✅ Prise en charge : Acte remboursé par l'Assurance Maladie. Aucun dépassement d'honoraires à l'Hôpital Cochin AP-HP.