Lung Biopsy
A lung biopsy is a procedure in which a small piece of tissue is removed from a lung, and then examined microscopically to determine the presence or absence of damage or disease. There are several types of lung biopsies: Bronchoscopic and needle biopsies are usually performed under mild sedation; open biopsy, video-assisted thoracoscopic surgery (VATS) and mediastinoscopy, because they require incisions, are performed under general anesthesia.
Reasons for Lung Biopsy
Lung biopsies are done for several reasons:
- To diagnose lung cancer or establish its stage
- To diagnose other lung conditions (such as sarcoidosis or mesothelioma)
- To further investigate abnormalities seen on other diagnostic tests
A lung biopsy is also used to investigate the cause of unexplained fluid collection in the lung.
Lung Biopsy Procedure
There are several methods for performing lung biopsies.
Bronchoscopic Biopsy
A lighted instrument called a bronchoscope is inserted through the mouth or nose into the bronchial passage to remove a lung-tissue sample. This method may be used if an infectious disease is suspected, or the abnormal lung tissue is located next to the bronchial tubes. It is also often used as a preliminary procedure before trying more invasive methods.
Needle Biopsy
A long needle is inserted through the chest wall to remove a sample of lung tissue. This method is used if the abnormal lung tissue is located close to the chest wall. During the biopsy, a CT scan, ultrasound or fluoroscopy is commonly employed to precisely guide the needle to the abnormal tissue.
Open Biopsy
An incision is made between the ribs to remove a sample of lung tissue. An open biopsy is usually performed when other biopsy methods have failed or cannot be used, or when a large piece of lung tissue is required for diagnosis.
Video-Assisted Thoracoscopic Surgery
The surgeon uses a thoracoscope (a type of endoscope), which is passed through a small incision in the chest, to remove a sample of lung tissue.
Mediastinoscopy
The space behind the breastbone in the middle of the chest is examined. This area, which separates the lungs, is known as the mediastinum; it contains lymph nodes, as well as the heart and other organs. During mediastinoscopy, a type of endoscope is used to locate and take a biopsy of one or more lymph nodes for microscopic examination.
Which type of biopsy is used depends on where the tissue sample will be taken from, and the overall health of the patient.
Risks of Lung Biopsy
Lung biopsies are generally safe, with the most serious risk being lung collapse (pneumothorax), of which there is a 15 percent chance. If pneumothorax occurs, a tube may be inserted in the chest to keep the lung inflated while the biopsy site heals. Other risks of lung biopsy include the following:
- Excessive bleeding or hemorrhage
- Infection
- Bronchial spasms
- Heart arrhythmia
- Blood clots
Allergic reaction to anesthesia or medication is also possible.
Recovery from Lung Biopsy
Recovery varies depending on the type of procedure performed and the type of anesthesia or sedation used. The patient is usually discharged as soon as blood pressure, pulse and breathing have stabilized. A chest X-ray may be performed immediately after the biopsy, and repeated in a few hours. A patient should expect the following symptoms, depending on the type of biopsy performed, during the recovery period:
- Dry mouth (from bronchoscope)
- Blood-tinged saliva or other secretions
- Tenderness for several days (from needle biopsy)
- Fatigue and possible aches
Pain relievers should be taken as recommended or prescribed. Aspirin and similar medications should be avoided because they can cause excessive bleeding. Any of the following should be reported to the physician:
- Shortness of breath
- Chest pain
- Difficulty or pain associated with breathing
- Coughing up blood
- Fever and/or chills
- Redness, swelling, bleeding or other drainage from the biopsy site
The patient is usually cautioned to avoid strenuous activities for a few days following the lung biopsy.