Biopsy of the Lung

Abstract

In this issue of The Annals are two articles dealing with methods for performing biopsies of lesions of the lung. The paper by Burt and co-workers (p 146) reports a prospective evaluation of aspiration needle biopsy, cutting needle biopsy, transbronchial biopsy, and open lung biopsy done synchronously in 20 patients with pulmonary infiltrates. The paper by Todd and co-workers (p 154) reports an experience with 2,114 aspiration needle biopsies. Burt and co-workers, of the National Cancer Institute, undertook a prospective study of 20 consecutive patients with pulmonary infiltrates undiagnosed by routine noninvasive procedures to investigate the diagnostic yield of four methods of lung biopsy performed synchronously on all patients. Open lung biopsy (94%) was most effective, followed by transbronchial (59%), cutting needle (53’/0), and aspiration needle (29%) biopsy. This is a unique study and well executed. Their findings of the superiority of open lung biopsy in the diagnosis of pulmonary infiltrates is understandable and endorsed. We question their recommendation that open lung biopsy be performed synchronously with transbronchial biopsy even though the latter technique was successful in the 2 cases in which open lung biopsy was not. The same effect could be achieved if transbronchoscopic biopsy were used in the cases in which open lung biopsy has failed. On the other hand, transbronchial biopsy could be included with the bronchoscopy that is commonly part of routine workup at most hospitals. We do not believe open lung biopsy need be monitored enddbronchially to detect hemorrhage. One should not be confused by the major differences in the results of needle biopsy between the two reports. The paper by Burt and associates concerns pulmonary infiltrates,