Lung Biopsy

A lung biopsy is a procedure in which a small piece of tissue is removed from the lung to be examined microscopically in order to determine the presence or absence of damage or disease. There are several types of lung biopsies, each useful depending on medical circumstances. Bronchoscopic and needle biopsies are usually done under mild sedation whereas open biopsies, VATS, or mediastinoscopy, since these require incisions, are performed under general anesthesia.

Lung biopsies are done for several reasons as follows:

• To diagnose lung cancer or to establish the stage of malignancy
• To diagnose other lung conditions, such as sarcoidosis or mesothelioma
• To further investigate abnormalities seen on other diagnostic tests, such as chest X-rays
• To investigate the cause of unexplained fluid collection in the lung

There are several methods used in performing lung biopsies, depending on where the sample will be taken from and the overall health of the patient:

Bronchoscopic Biopsy

During this type of biopsy a lighted instrument called a bronchoscope is inserted through the mouth or nose and into the bronchial passage to remove a lung tissue sample. This method may be used if an infectious disease is suspected, if the abnormal lung tissue is located next to the bronchial tubes, or as a preliminary procedure before trying more invasive methods.

Needle Biopsy

In a 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 a needle biopsy, a CT scan, ultrasound or fluoroscopy is commonly employed to guide the surgeon‘s needle with precision to the abnormal tissue.

Open Biopsy

In an open biopsy, the surgeon makes an incision between the ribs to remove a sample of lung tissue. An open biopsy is usually done when the other methods of lung biopsy have not been successful or cannot be used, or when a larger piece of lung tissue is required for diagnosis.

Video-assisted Thoracoscopic Surgery (VATS)

In VATS the surgeon uses a thoracoscope which is passed through a small incision in the chest to remove a sample of lung tissue.

Mediastinoscopy

In mediastinoscopy, the surgeon examines the space behind the breastbone in the middle of the chest. This area, which separates the two lungs, is known as the mediastinum, and contains lymph nodes, as well as the heart and other organs. During this procedure, using a special type of endoscope, the physician is able to locate and take a biopsy of one or more of the affected lymph nodes for microscopic examination.

Lung biopsies are generally safe procedures. There are, however, some risks associated with all types of lung biopsies. These should be discussed with the pulmonologist beforehand. Death resulting from a lung biopsy is an extremely rare occurrence, but lung biopsies should never be undertaken lightly.

The most serious risk during a lung biopsy is the collapse of the lung, known as a pneumothorax. There is a 15 percent chance of lung collapse occurring during a lung biopsy. If pneumothorax occurs, the doctor may need to place a tube in the chest to keep the lung inflated while the biopsy site heals. Other risks of a lung biopsy may include:

• Excessive bleeding or hemorrhage
• Infection
• Bronchial spasms
• Heart arrhythmias
• Allergic reactions to anesthesia or medications
• Blood clots

Recovery varies depending on the type of procedure performed and the type of anesthesia or sedation used. The patient will usually be discharged as soon as blood pressure, pulse, and breathing are stabilized. A chest X-ray may be performed immediately after the biopsy and repeated in a few hours. The patient should expect the following symptoms during the recovery period, depending on the type of biopsy performed:

• Dry mouth resulting from the use of the bronchoscope
• Blood tinged saliva or other secretions
• Tenderness for several days after a needle biopsy
• Fatigue and possible aches

Pain relievers should be taken as recommended or prescribed by the physician. Aspirin and similar medications should be avoided since they may cause excessive bleeding. The patient is usually cautioned to avoid strenuous activities for a few days following the lung biopsy, and to report any of the following to the doctor:

• 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