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Medical Author:

George Schiffman, MD, FCCP

George Schiffman, MD, FCCP

Dr. Schiffman received his B.S. degree with High Honors in biology from Hobart College in 1976. He then moved to Chicago where he studied biochemistry at the University of Illinois, Chicago Circle. He attended Rush Medical College where he received his M.D. degree in 1982 and was elected to the Alpha Omega Alpha Medical Honor Society. He completed his Internal Medicine internship and residency at the University of California, Irvine.

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Medical Editor:

Jerry R. Balentine, DO, FACEP

Jerry R. Balentine, DO, FACEP

Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.

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Biopsy is a sample of cells is removed for examination under a microscope. There are different methods to collect biopsy samples from the airway or lung tissue where the solitary pulmonary nodule is located.

Bronchoscopy: This procedure is used for solitary pulmonary nodules that are situated closer to the walls of the airways. A bronchoscope (a thin, flexible, lighted tube with a tiny camera at the end) is inserted through the mouth or nose and down the windpipe. From there, it can be inserted into the airways (bronchi) of the lungs. During bronchoscopy, the health care professional takes a biopsy sample from the solitary pulmonary nodule. If the lesion is not easily accessible on the airway wall or is smaller than 2 cm in diameter, a needle biopsy may be performed. This procedure is called a transbronchial needle aspiration (TBNA) biopsy. Usually, this technique is only successful with the aid of endobronchial ultrasound (EBUS).

Transthoracic needle aspiration (TTNA) biopsy: This type of biopsy is used if the lesion is not easily accessible on the airway wall or is smaller than 2 cm in diameter. If the solitary pulmonary nodule is on the periphery of the lung, a biopsy sample has to be taken with the help of a needle inserted through the chest wall and into the solitary pulmonary nodule. It is usually performed with CT guidance. With solitary pulmonary nodules larger than 2 cm in diameter, the diagnostic accuracy is higher (90% to 95%). However, the accuracy decreases (60% to 80%) in nodules that are smaller than 2 cm in diameter.

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