Abstract Thermal ablation is an established treatment for pulmonary nodules, conventionally performed after histopathologic confirmation of malignancy. We report the case of a 66-year-old woman with a history of left breast invasive ductal carcinoma (Bloom-Richardson grade II, score 7) with a 3-cm primary tumor and 3/19 axillary lymph nodes involved (pT2N1), and HER2 amplification detected by fluorescence in situ hybridization, who presented with a right lower lobe pulmonary nodule suspicious for metastasis. In contrast to standard practice, the lesion was first ablated under CT guidance, after which a coaxial core biopsy was obtained from the ablation zone. Histopathological analysis confirmed metastatic breast carcinoma, with preserved tissue architecture and immunohistochemical integrity (HER2 immunohistochemistry was 2+, and CISH confirmed HER2 amplification), despite a 4-hour interval between ablation and biopsy. No immediate procedural complications were observed. This case underscores the feasibility and diagnostic adequacy of delayed post-ablation biopsy and suggests that diagnostic integrity can be maintained even several hours after ablation.
Behzad et al. (2026) studied this question.