Illustration of lung biopsy with tree and medical instruments

Decoding Thoracic Tissue Sampling: A Guide to Lung Biopsy Techniques

Elliot Brynn in Health & Wellness August 2025 • 3 min read.

"Navigating the options for thoracic tissue sampling: Balancing accuracy, safety, and cost in lung and mediastinal biopsies."

In oncology, thoracic computed tomography (CT) scans often reveal abnormalities that necessitate tissue sampling for diagnosis and staging. Selecting the most suitable sampling method is crucial for maximizing information, ensuring patient safety, and minimizing costs.

A multidisciplinary discussion involving thoracic oncology team members is invaluable to determine the most appropriate method for each patient. Factors such as lesion location, required tissue amount, technique availability, safety profile, and expected diagnostic accuracy must be carefully considered.

This article aims to outline common tissue sampling methods, highlighting their respective advantages and disadvantages.

Lung Biopsy Techniques: Which One is Right for You?

Illustration of lung biopsy with tree and medical instruments

When pulmonary parenchymal lesions require sampling, several techniques are available, each with unique features and applications. These include conventional bronchoscopic biopsy (with or without endobronchial ultrasound (EBUS) and electromagnetic navigation), CT-guided biopsy, and video-assisted thoracoscopic surgery (VATS).

Conventional transbronchial needle aspiration (TBNA) is often used for central lung lesions, specifically those accessible within the segmental bronchus. Ideal candidates for TBNA include patients with large parenchymal lesions (at least 2-3 cm in diameter) and endobronchial lesions.

How it works: TBNA is performed under direct vision using a fiberoptic bronchoscope, with fluoroscopy used for distal lesions. Cytological samples are obtained, making on-site evaluation helpful.
Accuracy: TBNA has fair sensitivity (approximately 67%) for lesions larger than 2 cm, but lower sensitivity (approximately 33%) for smaller lesions.
Risks: The pneumothorax rate is about 3%, but is often negligible in daily clinical practice.
Benefits: TBNA can sample nearby lymph nodes, aiding in lung cancer staging. It's an outpatient procedure requiring sedation.
Cost: Approximately $2,100 (USD).

EBUS is a newer technique used with bronchoscopic biopsy to sample lesions adjacent to a bronchus but lacking a direct bronchial branch. Guided by radial or curvilinear ultrasound transducers, EBUS confirms needle tip placement in the lesion. Doppler ultrasonography helps identify and avoid nearby vascular structures.

Making Informed Decisions: A Collaborative Approach

Selecting the best method for lung or mediastinal lesion biopsy requires careful consideration of available options, involving specialists in surgery, pulmonary medicine, gastroenterology, and radiology. Key factors include lesion location, required tissue amount, cost, technique availability, safety, and expected diagnostic yield/accuracy. A collaborative, multidisciplinary approach ensures the best possible outcome for each patient.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1102/1470-7330.2010.9025, Alternate LINK

Title: Multidisciplinary Approach To Thoracic Tissue Sampling

Subject: Radiology, Nuclear Medicine and imaging

Journal: Cancer Imaging

Publisher: E-MED LTD

Authors: L.E. Quint

Published: 2010-01-01

Everything You Need To Know

What is the process of choosing the right lung biopsy technique?

The process of choosing a lung biopsy technique involves evaluating various methods, including bronchoscopy, CT-guided biopsy, and VATS. The best method depends on factors such as lesion location, the required tissue amount, technique availability, the safety profile, and expected diagnostic accuracy. A collaborative discussion among a thoracic oncology team is invaluable to determine the most appropriate method for each patient.

What is transbronchial needle aspiration (TBNA) and how is it used?

Conventional transbronchial needle aspiration (TBNA) is frequently employed for central lung lesions. It is performed under direct vision with a fiberoptic bronchoscope and fluoroscopy for distal lesions. It has a fair sensitivity for lesions larger than 2 cm, however, sensitivity is lower for smaller lesions. TBNA allows for sampling of nearby lymph nodes, which is crucial for staging of lung cancer. The pneumothorax rate is about 3%, which is often negligible in daily clinical practice.

What is Endobronchial Ultrasound (EBUS) and how does it improve the biopsy process?

EBUS is a more advanced technique that complements bronchoscopic biopsy, especially when dealing with lesions located near a bronchus but lack a direct bronchial branch. EBUS uses radial or curvilinear ultrasound transducers to guide the needle placement within the lesion, and Doppler ultrasonography aids in avoiding vascular structures. The use of EBUS enhances the precision of the biopsy procedure.

What factors influence the selection of the best method for a lung or mediastinal lesion biopsy?

Several factors are considered when choosing the best method for a lung or mediastinal lesion biopsy. These include lesion location, the tissue amount needed, cost, technique availability, safety, and the expected diagnostic yield or accuracy. A multidisciplinary approach, involving specialists in surgery, pulmonary medicine, gastroenterology, and radiology, is essential to ensure the optimal outcome for each patient. This collaborative approach maximizes the chances of accurate diagnosis and effective patient care.

Why is choosing the right lung biopsy technique so important in oncology?

Thoracic CT scans often reveal abnormalities that require tissue sampling for diagnosis and staging in oncology. The selection of the appropriate sampling method is crucial because it directly affects the amount of information that can be obtained, patient safety, and the overall cost of the procedure. Therefore, choosing the right technique is paramount for effective patient management and treatment planning.