Lung Biopsy

A lung biopsy is a procedure performed to isolate a sample of lung tissue to examine under a microscope for the presence of cancerous cells, infections, and other lung conditions. The procedure is used as a diagnostic tool for the confirmation and staging of cancer and lung conditions such as pneumonia and pulmonary fibrosis (scarring of the lungs). A lung biopsy is typically recommended when your physician suspects something unusual on your chest X-ray or CT scan.

Indications

There are various reasons for a lung biopsy to be indicated, including:

• To diagnose a lung infection or other lung condition
• To evaluate a mass or nodule seen on an imaging study of the chest
• To determine if a lung mass is cancerous (malignant) or non-cancerous (benign)
• To ascertain the type and stage of lung cancer
• To perform molecular profiling on lung cancer to detect mutations in cancer cells
• To follow up on an abnormality noted on a chest X-ray or CT scan
• To determine the cause of unexplained fluid accumulation in the lung

Preparation

Preparation for a lung biopsy may involve the following:

• Routine blood work and a review of your medical history 
• You should inform your doctor of any medications you are taking, as dose adjustments may be required.
• Your physician may also ask you to stop taking certain medications, such as blood thinners, aspirin, or NSAIDs.
• You should inform your doctor of any allergies to medications or any conditions you have such as heart disease.
• You need to refrain from solids or liquids at least 8 hours prior to the procedure.
• You should arrange for someone to drive you home after the procedure.
• A signed informed consent is obtained after the procedure has been explained.

Surgical procedure

There are several types of lung biopsy procedures that may be performed based on the type of lung condition you have. Some commonly performed lung biopsy procedures include:

Needle lung biopsy: After administering numbing medicine (local anesthetic) to the chest, your physician passes a needle through the chest wall into the area of the lungs that is suspect. A fluoroscopic (live X-ray imaging) or computed tomography (CT or CAT scan) is done to obtain a tissue sample. This type of biopsy may also be referred to as a transthoracic or percutaneous (through the skin) biopsy.

Transbronchial lung biopsy: This is a type of biopsy in which a bronchoscope – a thin, long fiber-optic tube with a light source and tiny camera – is passed through the nose or mouth, down the throat and into the main airways of the lungs after numbing the nose or throat with an anesthetic gel or spray. Tiny tools are then directed through the scope into the suspicious lung site to extract a sample.

Thoracoscopic lung biopsy: After administering local or regional anesthesia, your physician makes 3 small incisions on the chest between the ribs. A thoracoscope (a flexible, fiber-optic lighted tube with a video camera) and tiny tools are then passed through the incisions into the area of the lung to be biopsied, and a sample of lung tissue is extracted. A thoracoscopic biopsy is also referred to as a video-assisted thoracoscopic surgery (VATS) biopsy, as a video camera is used to guide the physician.

Open lung biopsy: This is a major surgery performed under general anesthesia. Your physician makes an incision in the skin on the chest and surgically removes a fragment of lung tissue for examination. Depending on the outcome of the biopsy, a more extensive procedure, such as the removal of a lung lobe, may also be performed at the time of the procedure.

Depending on the type of lung biopsy, the procedure may take from 30 minutes up to 2 hours.

Postoperative care

Following the procedure, you will be transferred to the recovery room where your nurse will monitor your vital signs. You will be discharged home once your pulse and blood pressure have stabilized, with the exception of open lung biopsy which requires at least a day of hospital stay for recovery. You may experience throat soreness or discomfort if a tube has been passed through your throat. Medications are provided as needed for comfort. You may also experience soreness at the biopsy site. Pain and anti-inflammatory medications are provided to address this, along with antibiotics to mitigate the risk of surgery-related infection. You are advised to rest for a few days after a lung biopsy and avoid any physical exertion until your physician gives approval. Follow-up appointments will be scheduled to monitor your progress.

Risks and Complications

Some of the risks and complications of a lung biopsy include:

• Pain at the biopsy site
• Bleeding in the lung
• Blood clots
• Infection
• Sore throat
• Pneumonia
• Allergic/anesthetic reactions
• Pneumothorax (collapsed lung)
• Pleural effusion

Summary

A lung biopsy is a procedure in which a small piece of lung tissue is removed for laboratory examination to determine lung conditions. It is typically a safe and effective method of detecting lung problems.