Skinny needle aspiration biopsy provides the most sensitive and least invasive method to obtain a tissue diagnosis. Needle placement can be guided by ultrasound, CT or fluoroscopy which varies between medical centers. The following summarizes the data obtained by three different centers:
| Researcher | No of Patients | % Tissue Diagnosis |
|---|---|---|
| Walls | 27 | 96% |
| Westcott | 422 | 96% |
| O'Connell | 23 | 69% |
For lesions adjacent and adherent to the chest wall, trucut biopsies are safe. In Walls, et. al., performance of 30 needle aspiration biopsies, pneumothorax was the only complication encountered and occurred in 10% of the time.
Three sputum cytologies are negative. The yield of sputum cytology is low.
| Researcher | No of Cases | % Positive |
|---|---|---|
| Walls | 18 | 6% |
| Hepper | 45 | 16% |
Bronchoscopy is normal. Pancoast lesions are peripheral in location and bronchoscopy often is non contributory. Fluoroscopic guided placement is difficult for apical lesions. In 20 cases reported by Walls, et. al., bronchoscopic biopsy and washings were non-diagnostic. However, bronchoscopy for purposes of staging in all patients suspected to have lung cancer is a good practice.