Skip to main content
  • Oral presentation
  • Open access
  • Published:

Imaging as a guide to tissue sampling

When assessing a patient with lung cancer, it is important to stage the tumor in order to determine prognosis and direct appropriate therapy. Although imaging findings, particularly with CT and PET, can suggest the correct tumor stage, imaging is imperfect in this regard; enlarged and/or hypermetabolic lymph nodes may require sampling for confirmation of presumed tumor stage. A major role for imaging is to direct the most optimal method of tissue sampling in order to establish the highest possible tumor stage, so that proper therapy may be instituted [1]. Lymph node biopsies may be performed using mediastinoscopy for lymph nodes that are adjacent to the trachea or carina; bronchoscopy with endobronchial ultrasound for lymph nodes adjacent to the trachea, carina, mainstem bronchi and more peripheral airways; video assisted thoracoscopic surgery (VATS) for lesions adjacent to the pleural surfaces; Chamberlain procedure for lymph nodes in the aortopulmonary window and anterior paraaortic regions; endoscopic ultrasound (EUS) for nodes adjacent to the esophagus; ultrasonography for nodes in the neck and supraclavicular regions; and CT biopsy for large, accessible nodes. Selection of the best method for obtaining a tissue sample necessitates consideration of various factors, including the location of the lesion, the need for sampling of single vs. multiple lymph node stations, the amount of tissue that is necessary to make a confident diagnosis, the expected diagnostic yield and accuracy of the technique, the cost and availability of the procedure at the patient’s institution, the expertise of the physicians, and the safety and risks involved.


  1. Quint LE: Multidisciplinary approach to thoracic tissue sampling. Cancer Imaging 2010, 10: S151-S155. 10.1102/1470-7330.2010.9025

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Leslie E Quint.

Rights and permissions

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Quint, L.E. Imaging as a guide to tissue sampling. cancer imaging 14 (Suppl 1), O7 (2014).

Download citation

  • Published:

  • DOI: