Invasive diagnostic techniques
| Procedure . | Yield . | Risk . | Limitations and comments . | ||
|---|---|---|---|---|---|
| Noncompromised . | Hematologic malignancy and HCT . | Noncompromised . | Hematologic malignancy and HCT . | ||
| Bronchoscopy with BAL | 10%-50%62 | 15%-60% (90% for IPA if use noncultural diagnostics)60,61,72-74 | Major complications < 1%-35%, severe 10%62,70,71 | Most complications minor (< 2%-28%); major complications (< 1%-8%)6,60,61,74,75 ; 10% life-threatening complications if respiratory compromise67 | Higher yields with guided bronchoscopic techniques |
| Not suitable for patients with poor lung reserve | |||||
| Transthoracic needle biopsy | 80%-90%62,63 | 50%-78%25,46,66 | Bleeding, pneumothorax (15%-24%, chest tube (6%-7%)64,65 | 15%-38% with 6%-16% requiring chest tube25,46,66 | Lesions optimally should be peripheral Better with larger lesions (> 1 cm) |
| Not suitable for patients with poor lung reserve and thrombocytopenia | |||||
| Open biopsy/excision | Gold standard62 | 16%-60%45,46,85,86 | Considerable morbidity and mortality | 13%-21%; 30 day mortality 2%-45%45,46,85,86 | Not suitable for patients with poor lung reserve and thrombocytopenia |
| Video-assisted biopsy | Comparable with open lung biopsy62,87 | Not adequately studied | 10% morbidity, < 1% mortality87,88 | Not adequately studied | Not suitable for central or large (> 3 cm) lesions, lesions < 1 cm, deeper in lung parenchyma |
| Ground-glass lesions may require localization procedure | |||||
| Procedure . | Yield . | Risk . | Limitations and comments . | ||
|---|---|---|---|---|---|
| Noncompromised . | Hematologic malignancy and HCT . | Noncompromised . | Hematologic malignancy and HCT . | ||
| Bronchoscopy with BAL | 10%-50%62 | 15%-60% (90% for IPA if use noncultural diagnostics)60,61,72-74 | Major complications < 1%-35%, severe 10%62,70,71 | Most complications minor (< 2%-28%); major complications (< 1%-8%)6,60,61,74,75 ; 10% life-threatening complications if respiratory compromise67 | Higher yields with guided bronchoscopic techniques |
| Not suitable for patients with poor lung reserve | |||||
| Transthoracic needle biopsy | 80%-90%62,63 | 50%-78%25,46,66 | Bleeding, pneumothorax (15%-24%, chest tube (6%-7%)64,65 | 15%-38% with 6%-16% requiring chest tube25,46,66 | Lesions optimally should be peripheral Better with larger lesions (> 1 cm) |
| Not suitable for patients with poor lung reserve and thrombocytopenia | |||||
| Open biopsy/excision | Gold standard62 | 16%-60%45,46,85,86 | Considerable morbidity and mortality | 13%-21%; 30 day mortality 2%-45%45,46,85,86 | Not suitable for patients with poor lung reserve and thrombocytopenia |
| Video-assisted biopsy | Comparable with open lung biopsy62,87 | Not adequately studied | 10% morbidity, < 1% mortality87,88 | Not adequately studied | Not suitable for central or large (> 3 cm) lesions, lesions < 1 cm, deeper in lung parenchyma |
| Ground-glass lesions may require localization procedure | |||||