The radiologist’s role in pathologic diagnosis of small lung nodules: radiographic methods of tissue acquisition

Over the past decade, chest computed tomography (CT) utilization has steadily increased in conjunction with lung cancer CT screening. As a result, small lung nodules have become an increasingly common finding. CT-guided lung biopsy plays a pivotal role in the sampling of these small lung nodules and the subsequent diagnosis of lung cancer. The success of lung biopsies has a substantial downstream impact on diagnosis and treatment planning. It is well-recognized that the efficacy of lung biopsy is both operator-dependent and patient-dependent. Several considerations are necessary for the safe and successful performance of CT-guided lung biopsy. A familiarity with biopsy contraindications and their management can drastically reduce serious complications, such as intractable hemorrhage. Conscientious patient preparation and empathic communication are essential for reducing patient anxiety while increasing patient tolerance for the procedure and its common complications. Strategic and precise nodule-targeting techniques are crucial for obtaining adequate tissue and for improving diagnostic accuracy. On-site cytologic assessment is a powerful tool that can further boost diagnostic yield while also reducing complication rates by eliminating the need for additional biopsy attempts. Vigilant observation and careful assessment throughout the procedure are key factors in the effective mitigation of the most frequently encountered complications. As personalized medicine plays an increasingly integral part in the diagnosis and treatment of early-stage lung cancers, coordination between radiologists, clinicians, pathologists, and the patient becomes especially important.