A lung biopsy is a medical procedure involving the removal of a small piece of lung tissue for examination under a microscope. Its purpose is to obtain a tissue sample to identify the presence of disease or other conditions affecting the lungs. A lung biopsy is a common diagnostic step when imaging tests reveal suspicious findings.
Why a Lung Biopsy is Performed
A lung biopsy is performed when imaging scans, such as a chest X-ray or CT scan, reveal an abnormal area in the lung. These abnormalities may appear as suspicious nodules, masses, or other changes in lung tissue, and the biopsy investigates their nature.
The procedure helps diagnose various lung conditions. It can identify whether a mass is malignant (cancerous) or benign (non-cancerous). Biopsies also diagnose infections, such as tuberculosis or fungal infections, and investigate inflammatory or interstitial lung diseases. The analysis of the tissue sample provides information that guides treatment decisions.
Different Methods of Lung Biopsy
Several methods are used to perform a lung biopsy, chosen based on the location and nature of the lung abnormality. These methods range from less invasive needle procedures to more involved surgical approaches. The selection of a specific technique depends on factors like the patient’s general health, the type of lung problem, and the precise location of the issue within the lung.
Transthoracic Needle Biopsy (TTNB)
A transthoracic needle biopsy (TTNB) involves inserting a needle through the chest wall to obtain a tissue sample. This procedure is performed under imaging guidance, such as a CT scan or ultrasound, to ensure precise needle placement. Local anesthesia is administered to numb the area, allowing the patient to remain awake.
The radiologist guides a needle through the skin and between the ribs into the lung to the suspicious area. Patients may experience pressure or discomfort. Two main types are used: fine-needle aspiration (FNA) collects fluid or cell clusters, while core needle biopsy (CNB) obtains larger tissue samples. CNB may provide more tissue for analysis, which can be useful for identifying the specific type of lung disease. This procedure takes about 30 to 45 minutes.
Bronchoscopy with Biopsy
Bronchoscopy involves inserting a flexible tube, called a bronchoscope, through the mouth or nose and guiding it into the airways. This method is useful for accessing areas of the lung close to the airways. Patients may receive medication to relax, and numbing medicine is sprayed into the throat to prevent gagging.
Once the bronchoscope is in place, instruments like forceps, brushes, or needles collect tissue samples from the lung or nearby lymph nodes. A transbronchial biopsy uses forceps to take samples from within the airways. Endobronchial ultrasound (EBUS)-guided biopsy is an advanced technique using ultrasound on the bronchoscope tip to visualize and biopsy lymph nodes and masses outside the airways but within the chest, allowing for targeted sampling. A bronchoscopy with biopsy takes less than 30 minutes.
Surgical Lung Biopsy
Surgical lung biopsies are more invasive and are generally reserved for cases where less invasive methods cannot provide a sufficient sample or a clear diagnosis. These procedures are performed in an operating room under general anesthesia, meaning the patient is asleep.
Video-assisted thoracoscopic surgery (VATS)
VATS is a minimally invasive surgical technique involving one or more small incisions in the chest wall. A thoracoscope, a thin tube with a camera, is inserted through an incision, providing a magnified view of the lung and chest cavity. Other instruments are inserted through additional incisions to remove tissue samples. VATS allows biopsies from lung tissue, the chest wall lining, or lymph nodes. This method is often preferred over open surgery due to faster recovery times.
Open Thoracotomy
An open thoracotomy involves a larger incision in the chest to directly access the lung and remove a tissue sample. This method is less common for diagnosis alone but may be used when a larger sample is needed or if other surgical interventions are planned simultaneously.
Preparing for Your Biopsy
Preparing for a lung biopsy involves several steps to ensure patient safety and the accuracy of the procedure. Healthcare providers will review the patient’s medical history, including pre-existing conditions or allergies, and perform a physical examination.
Blood tests check clotting ability and general health. Imaging tests, such as a chest X-ray or CT scan, are reviewed to confirm the biopsy area’s exact location.
Patients must discuss all current medications, especially blood thinners, which may need adjustment to reduce bleeding risk. Fasting instructions, typically avoiding food and drink for several hours, will be provided. Patients should arrange for transport home after the procedure, as driving may not be advised. Communicate any questions or concerns with the healthcare team.
What to Expect During and After the Procedure
During a lung biopsy, patient comfort and safety are monitored. Depending on the biopsy type, local anesthesia numbs the site, or general anesthesia puts the patient to sleep. Patients with local anesthesia might feel a brief stinging sensation, followed by pressure or mild discomfort. It is important to remain still and follow instructions, such as holding one’s breath during needle biopsies. Vital signs, including heart rate and oxygen levels, are continuously monitored.
After the biopsy, patients move to a recovery area for observation. Monitoring continues for several hours to watch for immediate considerations like a collapsed lung (pneumothorax) or bleeding. Pain management is provided for soreness or discomfort. Recovery times vary; needle biopsies allow discharge within hours, while surgical biopsies often require an overnight hospital stay. Results are usually available within a week, and follow-up appointments are scheduled to discuss findings.
Potential Considerations
While lung biopsies are generally safe, some considerations can arise. A common consideration is pneumothorax, where air leaks from the lung into the space between the lung and chest wall. This can cause shortness of breath but often resolves on its own; a chest X-ray checks for this. In some cases, a small tube may be inserted to remove air if the pneumothorax is larger or causes significant symptoms.
Bleeding is another consideration, as the biopsy takes a tissue sample. Minor bleeding along the needle tract is common and usually self-limited. Patients may cough up small amounts of blood, which typically subsides quickly.
Infection at the biopsy site is less common but can occur. Pain or soreness at the biopsy site is usually manageable with medication and improves within a few days. Healthcare providers take precautions to minimize these considerations, and serious complications are not common.