Percutaneous lung biopsy with a fine bore cutting needle (Vacu-Cut): improved results using drill technique.

BACKGROUND: Percutaneous transthoracic needle biopsy is used in the diagnosis of pulmonary and pleural lesions. The standard procedure using the Vacu-Cut cutting type of needle is the "thrust" technique in which the needle is rapidly forced through the lesion. In our experience this technique has a low yield of histological biopsy specimens. The diagnostic yield of a new biopsy technique ("drill" technique) using the Vacu-Cut needle was assessed.
METHODS: The series comprised 29 consecutive patients, 23 with localised peripheral pulmonary lesions and six with pleural lesions. The Vacu-Cut 1.2 mm needle was rotated and drilled by hand through the lesion.
RESULTS: Biopsy specimens 4-30 mm long were obtained in 20 of the 23 patients with pulmonary lesions; in three patients material was available for cytological examination only. The diagnostic yield in the 18 malignant pulmonary lesions was 89% and in the five non-malignant lesions 80%. Biopsy specimens 10-30 mm long were obtained in all patients with pleural lesions. The diagnostic yield in the four malignant and two non-malignant lesions was 100%. The total diagnostic yield in malignant lesions was 20 of 22 patients and in non-malignant lesions six of seven patients. The diagnostic yield in the entire series was 26 of 29 patients (90%). Pneumothorax occurred in seven of the patients and three needed a chest tube. There was no haemoptysis and no deaths.
CONCLUSIONS: The drill technique has a high diagnostic yield in both malignant and non-malignant pulmonary and pleural lesions, and is suggested as the ideal biopsy technique when using the Vacu-Cut needle.