Which procedure is most useful for obtaining tissue in peripheral lung lesions when cancer is suspected?

• A. Bronchoscopy
• B. Pleural Fluid Analysis
• C. Mediastinoscopy
• D. Transthoracic Needle Biopsy

Answer: (D)

Direct biopsy of a peripheral lung lesion is best accomplished with a CT- or fluoroscopy-guided transthoracic needle biopsy. When a lesion lies outside the central airways, accessing it through the chest wall to obtain tissue provides the highest diagnostic yield for cancer, since bronchoscopy mainly samples lesions within or near the airways and often misses peripheral masses. Pleural fluid analysis helps only if there is malignant effusion, and mediastinoscopy targets mediastinal lymph nodes rather than the peripheral lesion itself. The transthoracic approach allows precise targeting of the peripheral lesion to obtain histology or cytology, making it the most useful option for confirming cancer in peripheral lung nodules.