CT-guided percutaneous lung biopsy plays a crucial role in the diagnosis of pulmonary space-occupying lesions. With increasing emphasis on health, advancements in medical diagnostic imaging technology have been significant. Additionally, primary lung cancer has become one of the most common malignant tumors in China, with rising morbidity and mortality rates, and an annual mortality increase of 11.9%. Clinically, the incidence of pulmonary masses is gradually increasing. Approximately 25% to 35% of patients with pulmonary masses are candidates for percutaneous lung biopsy during the diagnostic process.
Pulmonary masses, especially peripheral lung cancers, often present with latent onset and lack specific imaging characteristics. The positive rate of sputum cytology is low, making clinical diagnosis challenging and pathological confirmation difficult. In cases where etiology or pathology remains unclear, treatment options are often limited, directly impacting patient prognosis. Zhang Xuezhe reported that the positive rate of lung biopsies ranges from 74% to 95%. In this group, CT-guided percutaneous needle biopsy provided pathological diagnoses for 91% of patients with pulmonary masses within a short period, offering reliable guidance for timely treatment. Furthermore, CT-guided lung biopsy can detect early-stage lung cancer; five cases of early peripheral lung cancer were identified in this group, with tumor diameters ranging from 1cm to 2cm, all confirmed by surgery.
Thus, for suspected pulmonary tumors with negative sputum cytology and bronchoscopy results, especially when lesion diameter is less than 2cm, CT-guided percutaneous lung biopsy offers high diagnostic value. Indications and contraindications must be strictly observed.
**Indications:**
1. Peripheral pulmonary lesions not confirmed by general inspection methods.
2. Lesions near the chest wall.
3. Diffuse intrapulmonary lesions of unknown origin.
4. Malignant pleural lesions unsuitable for thoracic surgery requiring clear histological typing for treatment planning.
5. Mediastinal masses near the chest wall with unknown nature, excluding hemangiomas.
6. Pathological diagnosis required before chemotherapy.
**Contraindications:**
1. Severe emphysema, pulmonary hypertension, cor pulmonale, pulmonary congestion.
2. Bullae, lung cysts, hydatid disease of the lung.
3. Suspected pulmonary vascular lesions such as arteriovenous malformations or aneurysms.
4. Strict bleeding tendencies.
5. Suppurative diseases of the lung or pleura.
6. Cachexia or inability to endure the procedure.
**Prevention of Complications:**
To enhance sensitivity, larger masses closer to the chest wall with good lung function should ideally use larger biopsy needles in different directions for multi-point sampling. Multiple lesions should be biopsied separately to increase the positive rate. Generally, lesions farther from the chest wall cause more lung tissue damage but less so in smaller lesions, while higher gas content in lung tissue increases the risk of pneumothorax. In this group, the incidence of pneumothorax and hemothorax was 5.7% (2/35) and 2.9% (1/35), respectively, lower than previously reported. No complications of needle tract tumor cell seeding were observed. Small amounts of pneumothorax require handling only if pulmonary compression exceeds 30%, in which case observation, exhaust, or closed drainage may suffice. Pulmonary hemorrhage appears as small infiltrates at the puncture site on CT scans, with about 10% of patients experiencing hemoptysis, mostly self-limiting. Moderate hemoptysis can be treated conservatively, such as with intramuscular injection of hemostatic agents or intravenous posterior pituitary vasopressin. Severe bleeding may indicate major vascular injury, necessitating emergency surgery if needed. Air embolism is rare but can be prevented by avoiding coughing during puncture and ensuring the pulmonary vein is not pierced.
In conclusion, CT-guided percutaneous lung biopsy holds great practical value for qualitative diagnosis of pulmonary masses, with high puncture-positive rates and specificity. It accurately locates lesion size, depth, and needle angle, allowing repeat scans for performance evaluation and constant correction of puncture direction and depth, particularly advantageous for small lesions. The procedure is simple, safe, accurate, minimally invasive, and highly confirmatory. With fewer complications and better patient tolerance, it compensates for deficiencies in other tests and holds significant clinical value in guiding hospital-based treatments.