Transthoracic lung cancer biopsy with radiological navigation

Abstract

Transthoracic biopsy (TTNB) is a minimally invasive surgical method for obtaining a biopsy from the volume of interest in the chest cavity by transcutaneous puncture of the chest wall. In oncopulmonology, this method is applied to obtain a biopsy from primary malignant and metastatic tumors localized in the lungs, mediastinum, pleura, chest wall, and its histological verification. TTNB with this or that navigation option has significant advantages: minimal invasiveness (compared with mediastinoscopy, thoracotomy, thoracoscopy) with precision biopsy specimen for histological, cytological, bacteriological and other studies; implementation of a true morphological diagnosis; reduction of the hospitalization time for patients at the diagnostic stage. Algorithm technology (TTNB with navigation + histopathological examination) is constantly developing and fundamentally improving (in parallel with the development and improvement of medical imaging technologies) for over 55 years. The main navigation technologies at TTNB are considered: fluoroscopy, ultrasound, computed tomography, electromagnetic navigation bronchoscopy, positron emission tomography, magnetic resonance imaging. Frequent and rare complications during TTNB are described. Attention is drawn to the uncertainty of TTNB. To protect the surgeon from DNA radiation damage during TTNB with X-ray or CT navigation in real time, it was proposed to apply a re-profiled drug: N-acetylcysteine – mucolytic, expectorant and antioxidant agent with radioprotective properties. Key Words: lung cancer, transthoracic biopsy, radiological navigation.