Needle Biopsy of the Lung. with Special Reference to Diffuse Lung Disease and the Use of a New Needle.

According to Scadding (1952) there are 83 causes of diffuse miliary or nodular shadows in the chest radiograph, some of which are manifestations of systemic diseases. It is hardly surprising that histological evidence is frequently necessary to make a definitive diagnosis. This may also apply to some localized lesions. Biopsy material is usually obtained by thoracotomy. However, even the modified small thoracotomy of Klassen, Anlyan, and Curtis (1949) carries a definite morbidity and even mortality, especially in such diseases as carcinomatosis and diffuse pulmonary fibrosis. Some thoracic surgeons are loath to perform a diagnostic thoracotomy, a procedure which they feel is regarded too lightly by some of their medical colleagues. A satisfactory alternative might be some form of needle biopsy. It is the purpose of this paper to show that this can be done safely, simply, and swiftly, and will provide a positive histological diagnosis in many patients. It should be remembered that a thoracotomy biopsy is not always conclusive, and a repeat procedure is scarcely feasible as with needle biopsy. This is not to deny that thoracotomy will still be required for certain inaccessible lesions. Needle biopsy can be broadly classed as aspiration and non-aspiration. Aspiration biopsy, using a syringe and needle, was first used by Leyden in Germany in 1883 to obtain bacteria in cases of pneumonia. Horder independently described the method in 1909. Aspiration biopsy became fairly popular in the decade 1930-40 (Craver and Binkley, 1939) until Ochsner and De Bakey (1942) condemned the procedure on the grounds of the possible spread of malignant and inflammatory lesions, although they did not document any proved cases. In recent years the aspiration technique seemed to be returning to favour (Gledhill, Spriggs and Binford, 1949). An aspiration biopsy is suitable for localized disease but is 1This material was read at the August 1962 meeting of the Thoracic Society of Australia in Melbourne and the October 1963 meeting of the Royal Australasian College of Physicians in Brisbane.