BackTable / VI / Podcast / Episode #156
Percutaneous Lung Biopsies: The Basics
with Dr. Fred Lee
We start off Part 1 of a 2 part series with Dr. Fred Lee discussing Percutaneous Lung Biopsy Technique, with tips and tricks to help your daily practice.
BackTable, LLC (Producer). (2021, September 27). Ep. 156 – Percutaneous Lung Biopsies: The Basics [Audio podcast]. Retrieved from https://www.backtable.com
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Dr. Fred Lee
Fred T. Lee Jr, MD is a professor of Radiology, Biomedical Engineering, and Urology, The Robert A. Turrell Professor of Imaging Science, and the Chief of Abdominal Intervention at the University of Wisconsin.
Dr. Christopher Beck
Dr. Chris Beck is a practicing interventional radiologist with Regional Radiology Group in New Orleans.
In this episode, Dr. Fred Lee and our host Dr. Chris Beck discuss tips for achieving safe and successful percutaneous lung biopsies.
They start by discussing the increasing popularity of core biopsy (as opposed to fine needle aspiration), since an adequate amount of specimen is needed for genetic testing and personalized medicine. Dr. Lee emphasizes that knowing the goals of lung biopsy for each individual patient helps him decide how much specimen to collect and how the specimen should be handled.
Next, Dr. Lee walks through his lung biopsy technique. He outlines the difference between conventional CT and CT with fluoroscopy. While CT with fluoroscopy can be more efficient, it poses radiation risk to the patient and the physician. To minimize radiation risks, he advises IRs to intermittently tap the foot pedal and stand lateral to the CT scanner. The doctors also discuss some of the trickiest lung regions to biopsy and ways to avoid pneumothorax.
Finally, Dr. Lee comments on the choice between percutaneous lung biopsies and electromagnetic navigation bronchoscopy, noting that each procedure has different advantages and risks. He encourages interventional radiologists and interventional pulmonologists to explore these options and take evidence-based approaches.
Throughout this episode, we cite data from Dr. Lee’s previous publications, which are cited below.
Percutaneous Lung Biopsy with Pleural and Parenchymal Blood Patching:
Results and Complications from 1,112 Core Biopsies: https://www.jvir.org/article/S1051-0443(21)01202-1/fulltext
[Dr. Christopher Beck]:
And you also talked about another thing I wanted to bring up, and I was going to bring it up in the context of moderate sedation versus local. It sounds like you guys do at moderate sedation for everything, but making it a point to do your biopsies on end-expiration, I think that's a good practice to get into.
I think sometimes there's room for variation where if you happen to... Sometimes lesions can pop into a better area if you happen to use a different breath-hole. But I think end-expiration tends to create the most reproducible location of a lesion.
[Dr. Fred Lee]:
Absolutely. And you can use respiration to your advantage, as you were saying. If you need to pull the nodule down to you a little bit, just have 'em take a very small breath and hold it. My issue is that when we start giving little sedation to patients, it's very hard to get a reproducible breath hold. And also it is...
Getting back to the balloon analogy again, puncturing a patient during inspiration is like filling a balloon and then sticking a needle into it. And I would rather have a deflated balloon and stick a needle into it with less pressure in the lung. I think it probably decreases your pneumothorax rate as well. But again, something we haven't proven, but we suspect.
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