Lung Biopsy

What is a lung biopsy?

A biopsy is a procedure done to remove a sample of tissue from the body so it can be examined. A lung biopsy is a procedure to take a small piece of a lung. This is done with a special biopsy needle. Or it’s done during surgery. The biopsy is done to look for lung disease, cancer, or another condition.

There are several types of lung biopsy:

  • Needle biopsy. A numbing medicine (local anesthetic) is put on the chest. A needle is put into the lung to take out a sample. A CT scan (a series of X-rays and a computer) or fluoroscopy (a type of X-ray “movie”) may be used to guide the biopsy needle into the right place. This type of biopsy is also called a closed, transthoracic, or percutaneous (through the skin) biopsy.
  • Transbronchial biopsy. This type of biopsy is done with a bronchoscope. This is a long, thin tube with a tiny camera. The bronchoscope is put in the throat and down into the main airways of the lungs.
  • Thoracoscopic biopsy. Medicine is used to put you to sleep (general anesthesia). Or local anesthetic is used. A flexible, lighted tube (endoscope) is put between the ribs, through the chest wall, and into the chest cavity. Biopsy tools are used through the endoscope to take out small pieces of lung tissue. This is also called video-assisted thoracic surgery (VATS) biopsy. Treatments can also be done during this procedure. They may include removing a nodule or other tissue.
  • Open biopsy. This is done under general anesthesia. This method is used if the sample from the needle biopsy is too small to get a diagnosis. A cut (incision) in the skin is made to access the lung. A piece of the lung is removed. Depending on the fast results of a biopsy, more surgery may be done during the procedure. This may include the removal of a lobe of the lung. An open biopsy requires an overnight hospital stay.

Why might I need a lung biopsy?

A lung biopsy may be done to:

  • Check an abnormal spot on the lung seen on a chest X-ray or other imaging test
  • To diagnose lung infection or other lung disease
  • Look for the cause of excess fluid in the lung
  • Find out if a lung tumor is cancer (malignant) or not cancer (benign)
  • To see how far lung cancer has spread (staging)

Your healthcare provider may have other reasons to advise a lung biopsy.

The type of biopsy done will depend on several factors. These may include your general health, the type of lung problem, and where the problem is in the lung.

What are risks of a lung biopsy?

All procedures have some risks.

The risks of an open lung biopsy may include:

  • Blood loss or blood clots
  • Pain or discomfort
  • Infection
  • Pneumonia
  • Problems from general anesthesia

The risks of a needle or transbronchial lung biopsy may include:

  • Air in the space between the lung covering (pleural space) that causes the lung to collapse (pneumothorax)
  • Bleeding in the lung
  • Infection

Your risks may vary depending on your general health and other factors. Ask your healthcare provider which risks apply most to you. Talk with him or her about any concerns you have.

How do I get ready for a lung biopsy?

Your healthcare provider will explain the procedure to you. Ask him or her any questions you have. You may be asked to sign a consent form that gives permission to do the procedure. Read the form carefully. Ask questions if anything is not clear.

Tell your healthcare provider if you:

  • Are pregnant or think you may be pregnant
  • Are allergic to contrast dye or iodine
  • Are sensitive to or allergic to any medicines, latex, tape, or anesthetic medicines (local and general)
  • Take any medicines, including prescriptions, over-the-counter medicines, vitamins, and herbal supplements
  • Have had a bleeding disorder
  • Take blood-thinning medicine (anticoagulant), aspirin, or other medicines that affect blood clotting

Make sure to:

  • Stop taking certain medicines before the procedure, if instructed by your healthcare provider
  • Not eat or drink for 8 hours before the procedure, or as instructed by your healthcare provider
  • Plan to have someone drive you home from the hospital
  • Follow any other instructions your healthcare provider gives you

You may have blood tests or other tests or exams before the procedure. Your healthcare provider will tell you more.

What happens during a lung biopsy?

You may have your procedure as an outpatient. This means you go home the same day. Or it may be done as part of a longer stay in the hospital. The way the procedure is done may vary. It depends on your condition and your health care provider's methods. In most cases, a lung biopsy will start like this:

  1. You will be asked to remove your clothes. If so, you will be given a hospital gown to wear. You may be asked to remove jewelry or other objects.
  2. You will sit or lie down on a procedure table.
  3. An intravenous (IV) line will be put into your arm or hand.

For a needle lung biopsy

  1. An X-ray or CT scan may be done. This it to find the exact biopsy site. The skin over this area will be marked.
  2. The skin where the needle will be put in will be cleaned with an antiseptic solution.
  3. A numbing medicine (local anesthetic) will be injected into the area.
  4. You will need to hold still and not cough. You will be asked to hold your breath at certain times during the procedure.
  5. A small cut (incision) will be made over the biopsy site. The healthcare provider will put the needle between your ribs and into your lung through this incision. You may feel discomfort or pressure when the needle goes into your lung.
  6. One or more samples of lung tissue will be taken.
  7. The biopsy needle will be removed. Firm pressure will be applied to the site until any bleeding has stopped.
  8. The incision will be closed with stitches (sutures) or adhesive strips, if needed. A bandage or dressing will be put on the area.
  9. The lung samples will be sent to a lab.
  10. You may have a chest X-ray taken right after the biopsy.

For a transbronchial lung biopsy

  1. You will be awake during the procedure. You will be given medicine to help you relax (sedative).
  2. You may be given oxygen through a nasal tube or face mask. Your heart rate, blood pressure, and breathing will be watched during the procedure.
  3. An X-ray other imaging test may be done. This it to find the exact biopsy site. The skin over this area will be marked.
  4. Numbing medicine will be sprayed into the back of your throat. This is to prevent gagging as the bronchoscope is passed down your throat. The spray may have a bitter taste to it. Once the tube passes down your throat the gagging feeling will go away.
  5. You won’t be able to talk or swallow saliva during the procedure. Saliva will be suctioned from your mouth as needed.
  6. The healthcare provider will move the bronchoscope down your throat and into the airways. You may have some discomfort. Your airway will not be blocked. You can breathe around the bronchoscope. You will be given extra oxygen if needed.
  7. Tissue samples will be taken through the bronchoscope using a needle, forceps, or a brush.
  8. The healthcare provider will remove the bronchoscope.
  9. The lung samples will be sent to a lab.

For a thoracoscopic lung biopsy

  1. You will be given general anesthesia. This is medicine that prevents pain and lets you sleep through the procedure.
  2. A breathing tube will be put into your throat and hooked up to a breathing machine (ventilator). Your heart rate, blood pressure, and breathing will be watched during the procedure.
  3. Hair in the area of surgery may be trimmed. The skin in the area will be cleaned with an antiseptic solution.
  4. A cut (incision) will be made on your chest between the ribs. The thoracoscope will be put through this incision. One or more other incisions may be made at other place on your chest. These are for the tools to be used during the procedure.
  5. The area of the lung to have a biopsy will be found through the thoracoscope. One or more tissue samples will be taken from this area.
  6. A sample may be frozen and examined right away. This is called a frozen section. Depending on the results, more surgery may be done on the lung at this time. For example, a larger section of lung or an entire lung lobe may be removed.
  7. After the biopsy is done, one or more tubes may be put into your chest. These are to help remove air and fluid after surgery.
  8. The skin incision will be closed with stitches (sutures) or adhesive strips. A bandage or dressing will be put on the area.

For an open lung biopsy

  1. You will be given general anesthesia. This is medicine that prevents pain and lets you sleep through the procedure.
  2. A breathing tube will be put into your throat and hooked up to a breathing machine (ventilator). Your heart rate, blood pressure, and breathing will be watched during the procedure.
  3. Hair in the area of surgery may be trimmed. The skin in the area will be cleaned with an antiseptic solution.
  4. A soft, flexible tube (catheter) may be put into your bladder. This is to drain urine during the procedure.
  5. A cut (incision) will be made on the front of your chest at the level of the lobe to be removed. The incision will go under your arm around to your back.
  6. When the ribs can be seen, a special tool will be used to spread them apart. The lung will be examined.
  7. A piece of tissue will be removed from the lung. A sample may be frozen and examined right away. This is called a frozen section. Depending on the results, more surgery may be done on the lung at this time. For example, a larger section of lung or an entire lung lobe may be removed.
  8. One or more tubes may be put into your chest. These are to help remove air and fluid after surgery.
  9. The skin incision will be closed with stitches (sutures) or staples. A bandage or dressing will be put on the area.
  10. A thin tube (epidural catheter) may be put in. This is done to send pain medicine into your back. It may be done in the operating room or in the recovery room.

What happens after a lung biopsy?

After the procedure, you will spend some time in a recovery room. You may be sleepy and confused when you wake up from general anesthesia or sedation. Your healthcare team will watch your vital signs, such as your heart rate and breathing. You’ll be given pain medicine if you need it.

A chest X-ray may be done right after the biopsy and repeated in a few hours. This is to make sure your lungs are okay. After a transbronchial lung biopsy, you may be told to gently cough up and spit your saliva into a basin. This is so a nurse can check your secretions for blood.

If your biopsy was done using a bronchoscope, you may have some throat discomfort. You will not be allowed to eat or drink until your gag reflex has returned. You may notice some throat soreness and pain with swallowing for a few days. This is normal. Using throat lozenges or gargle may help.

If you had an outpatient procedure, you will go home when your healthcare provider says it’s okay. Someone will need to drive you home.

The biopsy site may be tender or sore for several days. Follow all the instructions your healthcare provider gives you for wound care and bathing. You can take pain medicine as advised by your healthcare provider. Aspirin and certain other pain medicines may increase bleeding. Make sure to take only the medicines your healthcare provider advises.

At home, you can go back to your normal diet and activities if instructed by your healthcare provider. You may need to not do strenuous physical activity for a few days.

Call your healthcare provider if you have any of the below:

  • Fever of 100.4°F (38°C) or higher
  • Feeling short of breath
  • Chest pain
  • Trouble breathing
  • Pain with breathing
  • Coughing up blood
  • Redness or swelling of the biopsy site or incisions
  • Blood or other fluid leaking from the biopsy site or incisions

Your healthcare provider may give you other instructions after the procedure.

Next steps

Before you agree to the test or the procedure make sure you know:

  • The name of the test or procedure
  • The reason you are having the test or procedure
  • The risks and benefits of the test or procedure
  • When and where you are to have the test or procedure and who will do it
  • When and how will you get the results
  • How much will you have to pay for the test or procedure

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