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There are different types of biopsies one can receive: bronchial biopsies, transbronchial biopsies, ultrasound-guided needle biopsies, and transthoracic needle biopsies. Bronchial biopsies, ultrasound-guided needle biopsies, and transthoracic needle biopsies are usually taken because of clinically suspected tumor. Three cylinders are recommended for transthoracic needle biopsy, four to eight pieces are recommended for bronchial biopsies, and three to five punches should be done in ultrasound-guided needle biopsy. Rapid on-site evaluation (ROSE) is recommended if logistically possible. This will enable to control the quality of the FNA-derived material, and in case of insufficient tissues, the procedure can be repeated. Transbronchial biopsies are most often taken for the diagnosis of non-tumor diseases. At least four to six pieces are recommended. Ideally these are taken under radiological control. Video-guided or ultrasound-guided systems are available, which increase the sensitivity of this method. However, if the transbronchial biopsy is not representative or nondiagnostic, we recommend to proceed to videothoracic surgery.

Image-guided percutaneous transthoracic needle biopsy of the lung is a well-established method for the histological diagnosis of pulmonary lesions. The purpose of this review is to describe the different technical modalities including the biopsy procedures and sample conditioning methods. The main complications and the influence of various variables on the complication rate are discussed. The accuracy and sensitivity of this diagnostic method are reported with emphasis on patients with suspected malignancy and/or infection. These data are useful for predicting the risk of complications before the procedure and, therefore, for helping to select those patients most likely to benefit.

The development of the techniques of organ biopsy in other fields of medicine have led to improved treatment, especially in renal and hepatic disorders. Biopsy techniques have slowly been accepted in the cardiac field. Transthoracic needle biopsy or limited thoracotomy have been associated with an unacceptable morbidity and mortality (15, 16, 17). The development of a catheter bioptome by Konno and Sakakibara (5) has represented a major advance in technique. There were, however, some disadvantages in the design of the Konno cardiac biopsy forceps and a decade later these have largely been overcome.