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Interventional radiology plays a key role in the diagnosis of suspected pulmonary nodular lesions.
The sample of a vital specimen is critical for lesion typing and characterization. Larger the specimen, higher is the possibility to obtain sufficient material for receptors (EGFR receptor) analysis with important prognostic implications.

TECHNIQUE AND PROCEDURAL STEPS
Computed tomography is the gold standard imaging modality for lung biopsy guidance, even if ultrasonography and magnetic resonance have been also described in the literature. Patient collaboration is essential because the lung moves during the respiratory acts (inflation and deflation). The patient is positioned on the CT sliding bed in a comfortable position because the procedure has a variable duration of about 20-60 minutes in which position should be maintained invariate. Percutaneous Intercostal approach is always adopted: after that local anesthesia is performed with a small needle the biopsy needle is inserted across the intercostal space and the lung parenchyma up to the nodule. Needle sampling system is activated once the tip is properly located in the nodule and the needle is extracted.
All the procedure is performed under imaging guidance and needle tip position can always be checked if necessary.

COMPLICATION AND MANAGEMENT
In a small number of cases, complications may occur during the lung biopsy procedure; among these, pneumothorax and parenchymal bleeding are the most common.

- Pneumothorax is defined as the entry of air into the pleural cavity resulting in increased intra-cavitary pressure and partial / complete collapse of the lung parenchyma. Pneumothorax occurs in almost 20% of all lung biopsy procedure but in the majority of cases it has no clinical relevance and the patient remains asymptomatic. A small number of patients (5% of the 20% reported above) indeed experiences minimal respiratory discomfort during or after the procedure. The cause of pneumothorax is usually the small superficial hole induced by the needle and the risk increases if multiple trans-pleural passes are performed during the procedure. Other risk factors are emphysema, small and deep lesions, poor patient collaboration. Pneumothorax management is achieved with chest tube placement usually performed across the biopsy needle percutaneous puncture site, avoiding a new puncture. The procedure is similar to that for pleural collection ([ Ссылка ])

- Parenchymal bleeding occurs when the needle passes through vessels in the lung parenchyma. This condition is more frequent when the lesion is close to the hilum or when the needle path is longer. Moderate hemoptysis is expected in these patients as the consequence of alveolar filling but it is usually self-limiting. In a very poor number of cases the bleeding persists and an endovascular management by embolization is required.

The video shows a case of lung biopsy in which the procedure is explained step by step; in addiction, anchor technique is explained: a first needle is placed near or peripherally within the lesion, allowing lung stabilization (reduction of the respiratory excursion), and the biopsy is performed with a second needle, larger in size, providing a major quantity of tissue for histological analysis.
In the proposed case, We show the anchor technique: a first needle is placed near or peripherally within the lesion, allowing lung stabilization, and the biopsy is performed with a second needle.

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