These guidelines have been developed at the request of the Standards of Care Committee of the British Thoracic Society (BTS) and with the agreement of the Royal College of Radiologists and the British Society of Interventional Radiology, and approval of the Royal College of Pathologists in respect of the pathology recommendations and the Society of Cardiothoracic Surgeons of Great Britain and Ireland.

Lung biopsy is a relatively frequently performed procedure with considerable benefit for patient management but it may, on rare occasions, result in the death of the patient. It is a multidisciplinary procedure involving respiratory physicians, surgeons, and radiologists with an interest in chest diseases.

The aim of the group was to produce formal evidence based guidelines for subsequent use by those referring patients for the procedure and for those performing it.

The areas covered by these guidelines are as follows:





The following areas are not covered by these guidelines:





### Validity and grading of recommendations

The criteria for assessing the levels of evidence and grading of recommendations were based on those recommended in the Scottish Intercollegiate Guidelines Network in 19951 using the Agency of Health Care Policy and Research model used in some other BTS guidelines (tables 1 and 2).

View this table:

 Table 1 
Categories of evidence185



View this table:

 Table 2 
Grading of recommendations



It should be noted that there are very few randomised trials comparing the various aspects of lung biopsy and, for that reason, more detailed systems of categorisation such as that of the Scottish Intercollegiate Guidelines Network published in 2001 were not used.2

The papers selected by searching PubMed and Medline were assessed by the members of the working group and decisions on levels of evidence for each paper were made by …

https://thorax.bmj.com/content/thoraxjnl/58/11/920.full.pdf

Guidelines for radiologically guided lung biopsy

CT-guided needle biopsy of lung lesions: a survey of severe complication based on 9783 biopsies in Japan.

Diagnostic Efficacy of PET-FDG Imaging in Solitary Pulmonary Nodules* Potential Role in Evaluation and Management

BACKGROUND Few studies have directly measured the age-, sex-, and race-specific risks of lung cancer incidence and mortality among never tobacco smokers. Such data are needed to quantify the risks associated with smoking and to understand racial and sex disparities and temporal trends that are due to factors other than active smoking. METHODS We measured age-, sex-, and race-specific rates (per 100,000 person-years at risk) of death from lung cancer among more than 940,000 adults who reported no history of smoking at enrollment in either of two large American Cancer Society Cancer Prevention Study cohorts during 1959-1972 (CPS-I) and 1982-2000 (CPS-II). We compared lung cancer death rates between men and women and between African Americans and whites and analyzed temporal trends in lung cancer death rates among never smokers across the two studies by using directly age-standardized rates as well as Poisson and Cox proportional hazards regression analyses. All statistical tests were two-sided. RESULTS The age-standardized lung cancer death rates among never-smoking men and women in CPS-II were 17.1 and 14.7 per 100,000 person-years, respectively. Men who had never smoked had higher age-standardized lung cancer death rates than women in both studies (CPS-I: hazard ratio [HR] = 1.52, 95% confidence interval [CI] = 1.28 to 1.79; CPS-II: HR = 1.21, 95% CI = 1.09 to 1.36). The rate was higher among African American women than white women in CPS-II (HR = 1.43, CI = 1.11 to 1.85). A small temporal increase (CPS-II versus CPS-I) in lung cancer mortality was seen for white women (HR = 1.25, CI = 1.12 to 1.41) and African American women (HR = 1.22, CI = 0.64 to 2.33), but not for white men (HR = 0.89, CI = 0.74 to 1.08). Among white and African American women combined, the temporal increase was statistically significant only among those aged 70-84 years (P < .001). CONCLUSIONS Contrary to clinical perception, the lung cancer death rate is not higher in female than in male never smokers and shows little evidence of having increased over time in the absence of smoking. Factors that affect the interpretation of lung cancer trends are discussed. Our novel finding that lung cancer mortality is higher among African American than white women never smokers should be confirmed in other studies.

/pdf/lung-cancer-death-rates-in-lifelong-nonsmokers-4yyqd8jhsl.pdf

Lung Cancer Death Rates in Lifelong Nonsmokers

Positron emission tomography (PET) is now an important cancer imaging tool, both for diagnosis and staging, as well as offering prognostic information based on response. This report attempts to comprehensively review the value of PET in the locoregional and distant staging of non-small cell lung cancer (NSCLC), illustrate the potential effects on patient management, and give a short overview of newer applications. PET sets the gold standard in the evaluation of an indeterminate solitary pulmonary nodule or mass, where PET has proven to be significantly more accurate than computed tomography (CT) in the distinction between benign and malignant lesions. In the evaluation of metastatic spread to locoregional lymph nodes, PET is significantly more accurate than CT, so that invasive surgical staging may be omitted in many patients with negative mediastinal PET images. In patients with positive mediastinal PET images, invasive surgical staging remains mandatory because of the possibility of false-positive findings due to inflammatory nodes or granulomatous disorders. In the search for metastatic spread, PET is a useful adjunct to conventional imaging. This may be due to the finding of unexpected metastatic lesions or due to exclusion of malignancy in lesions that are equivocal on standard imaging. However, at this time, PET does not replace conventional imaging. Large-scale randomized studies are currently examining whether PET staging will actually improve the appearance of lung cancer outcome.

The Role of PET Scan in Diagnosis, Staging, and Management of Non-Small Cell Lung Cancer

Transthoracic needle biopsy has become a frequently used method for obtaining tissue for diagnosis of pulmonary lesions The procedure carries an inherent risk of pneumothorax and hemorrhage, the latter usually manifested by transient hemoptysis Data on 430 patients who underwent transthoracic needle aspirations from 1968 through 1977 were studied to determine accuracy and complications of this procedure as related to lesion type and location Malilgnant disease, most often metastatic, was present in all but 10 patients Also, 86% of patients were more than 50 years of age and most were not candidates for operation Sufficient tissue for diagnosis was obtained in 82% of cases The diagnostic yield diminished significantly in central lesions less than 2 cm in size Pneumothorax and hemoptysis or pulmonary hemorrhage were the most common complications Biopsy of central lesions, especially those in the mediastinum, were more often associated with pneumothorax, whereas lesions near the hilar region were more susceptible to hemorrhagic complications Two deaths occurred, both from hemorrhage after biopsy in cavitating lesions with air/fluid levels The incidence of pneumothorax was also higher in cavitating lesions Fewer complications occurred with biopsy of lesions along the pleural surface and lesions in the periphery of the lung

Transthoracic needle biopsy: accuracy and complications in relation to location and type of lesion.

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Transthoracic needle biopsy: accuracy and complications in relation to location and type of lesion.