Thorax 1987;42:858-862 Drill biopsy in the diagnosis of lung lesions

A high speed pneumatic drill was used to perform 190 percutaneous transthoracic biopsies in 161 patients. The resultant cores of tissue provided a definite diagnosis in 146 patients, giving a success rate of 90 7%. Complications occurred in 58 patients, subcutaneous emphysema being the most common, though only seven patients required active treatment, giving a rate of 3-7% for important complications. One patient died within 24 hours of the biopsy procedure owing to asphyxia resulting from aspiration of the contents of an acutely dilated stomach. Our experience clearly establishes that the drill biopsy as used by us is simple and safe and can be carried out in an outpatient department, yielding better overall results than any other procedure for closed biopsy of the lung currently practised. Chest radiography, bronchoscopy, and pulmonary function studies are helpful for detecting pulmonary and mediastinal abnormalities, but specific diagnosis often requires microbiological and histopathological examination of the affected tissue. There has thus been an increasing demand for lung biopsy procedures. With the development of a range of new biopsy instruments and advanced cytological techniques, procedures for closed biopsy of the lung have increasingly usurped the place of the open approach. In 1969 Steele and Winstanley' claimed that closed lung biopsy using a high speed pneumatic drill yields, with a low incidence ofcomplications, a larger sample for the pathologist and thereby enhances the diagnostic accuracy. Impressed by their results, we adopted pneumatic drill biopsy of the lung as a routine practice; this report presents an analysis of our nine years' experience of the method.