Overview Pulmonary puncture biopsy is a widely used technique that can provide effective diagnostic and therapeutic assistance. Although rarely fatal, it requires multidisciplinary collaboration between respiratory physicians, thoracic surgeons and radiologists. Indications 1, new or progressively larger isolated nodules on chest film or CT, and not easily reached by bronchoscopic sampling. 2, Multiple nodules in the lungs, where the patient has no history of malignancy, or has a history of more than one malignancy, or where the malignancy is in remission after treatment. 3, persistent local infiltrates, whether single or multiple, which cannot be diagnosed after sputum examination, blood culture, serological examination or bronchoscopy. 4, hilar mass Contraindications 1, platelets <100000/ml 2, INR >1.5 3, severe emphysema Surgical steps and key points According to the patient’s CT picture before puncture, draw up the best puncture route and choose the suitable puncture position. Ask the patient to brake and breathe in a calm state during the scan, and avoid breathing heavily. The steps include: 1.localization image scan; 2.pre-scan: after the localization slice scan, select the level where the lesion is located on the localization slice, the scan area includes the need to include the complete lesion, and determine the skin puncture point by the resulting scan image using the position of the rib space and the distance measured by the scale; 3.after 2% lidocaine anesthesia of the puncture point, instruct the patient to hold his breath and puncture according to the angle and depth of the needle, repeat Scan to confirm the position of the needle tip, adjust the angle and depth of needle entry, and even adjust the puncture point and path until the needle tip position is appropriate for the lesion and remove the specimen; 4. Review the CT for any short-term complications. Complication prevention and management Fatalities The literature reports very few cases of death from lung biopsy, generally in the range of 0.07-0.47%. Causes include acute pulmonary hemorrhage or pulmonary hematoma, cerebrovascular or coronary gas embolism due to gas entering the pulmonary veins, and severe hemopneumothorax. The incidence of pneumothorax is 0-61%, with only 3.3-15% of patients requiring chest drainage. Subpleural lesions and lesions <50px from the pleura have a significantly higher incidence of pneumothorax on biopsy, followed by periportal lesions, mainly due to the long distance to the punctured lung. For non-tension pneumothorax, if the patient has no obvious symptoms of hypoxia, no special treatment is usually required, and in severe cases, chest drainage can be given. For patients with severe emphysema should be listed as a contraindication to puncture. < span="">The incidence of pneumothorax is significantly higher, followed by perihilar lesions, mainly due to the long distance of the punctured lung. For non-tension pneumothorax, if the patient has no obvious symptoms of hypoxia, no special treatment is usually required, and in severe cases, chest drainage can be given. For patients with severe emphysema should be listed as a contraindication to puncture. <--> Pulmonary hemorrhage The incidence is in the range of 5-16.9%, with or without hemoptysis, and the depth of the lesion is the main factor of pulmonary hemorrhage. No special treatment is usually required, and if the hemoptysis is large, hemostatic drugs may be administered. The incidence of hemothorax is about 1.5%. An overt hemothorax is rare and may be due to bleeding from the internal mammary artery or intercostal artery or vein. Other complications Case reports mention needle tract implantation metastasis of the tumor, pericardial tamponade, and pulmonary infection (pleurisy) resulting in pus accumulation in the pleural cavity. In conclusion, percutaneous lung biopsy is one of the most accurate non-surgical minimally invasive methods for the diagnosis of lung lesions, with few adverse events and a high diagnostic rate!