The role of percutaneous needle biopsy in the management of patients with peripheral pulmonary nodules

Although percutaneous needle biopsy is not appropriate for all patients with peripheral pulmonary nodules, the procedure is indicated in any patient with a peripheral pulmonary nodule that is not radiographically characteristic of a benign or malignant process. It is also indicated in patients with radiographic evidence of a malignant tumor who either refuse operation until a precise diagnosis has been established or have significant impairment of pulmonary function so that an exploratory thoracotomy would be hazardous. Percutaneous needle biopsy is unnecessary in those patients who have characteristic or strongly suggestive radiographic evidence of a malignant tumor. Percutaneous needle biopsy is also not indicated to rule out the possible presence of a peripheral oat cell carcinoma. Oat cell carcinomas seldom present as a peripheral pulmonary nodule. Even if a preoperative diagnosis of oat cell carcinoma is established, a peripheral oat cell carcinoma without radiographic evidence of mediastinal lymphadenopathy is best managed by a lobectomy supplemented by adjuvant chemotherapy. Therefore, clinical management would not be altered by a preoperative diagnosis.