A transbronchial lung biopsy is a medical procedure that involves obtaining a small tissue sample from the lung. A doctor guides a bronchoscope, a thin, flexible tube with a camera, through the mouth or nose into the airways. The collected lung tissue is then examined under a microscope to help identify the cause of lung-related symptoms.
Purpose of the Procedure
A transbronchial lung biopsy helps diagnose various lung conditions when other tests, such as X-rays or scans, are inconclusive. It provides a direct tissue sample, often necessary for a definitive diagnosis. It helps identify issues like interstitial lung diseases, involving scarring or inflammation of lung tissue, and various types of infections, including those caused by fungi or mycobacteria.
The biopsy also diagnoses certain types of lung cancer or determines the stage of a known malignancy. When lung nodules or masses are observed on imaging tests, a transbronchial biopsy can help determine if they are benign (non-cancerous) or malignant (cancerous). For individuals who have received a lung transplant, this procedure can help monitor for signs of organ rejection.
Procedure Overview
Before a transbronchial lung biopsy, patients receive instructions, including fasting for 6 to 12 hours to minimize aspiration risk. Patients may also be advised to temporarily stop certain medications, especially blood thinners, to reduce bleeding risk. Informed consent is also obtained.
During the procedure, patients are usually given a local anesthetic to numb the throat and may receive intravenous (IV) sedation to help them relax. The flexible bronchoscope is carefully inserted through the mouth or nose and guided into the lung airways. The doctor uses the bronchoscope’s camera and light to visualize airways and identify the specific area for tissue collection.
Tiny forceps or a brush collect small pieces of lung tissue through the bronchoscope. In some cases, saline fluid may flush the area to collect cells. Fluoroscopy, a real-time X-ray, may guide the bronchoscope for accurate tissue collection, especially for deeper lesions. The entire procedure usually takes less than 30 minutes and is commonly performed on an outpatient basis, meaning patients typically go home the same day.
Post-Procedure Care and Recovery
After a transbronchial lung biopsy, patients are monitored in a recovery area for one to two hours. Healthcare professionals observe for complications like changes in breathing or bleeding. A chest X-ray may be performed to check for a collapsed lung (pneumothorax), a rare but possible complication.
Patients may experience temporary side effects, including a sore throat, husky voice, or cough for a few days. Coughing up small amounts of blood-tinged mucus is common and should decrease over a few hours. At home, patients should rest and avoid strenuous activities or heavy lifting for a few days. Avoiding air travel for about seven days after the procedure is also recommended.
Patients can usually return to work the day after the procedure, unless instructed otherwise. Biopsy results are usually available within about a week. The healthcare team will schedule a follow-up appointment to discuss the findings and any necessary treatment or follow-up care.
Understanding Potential Considerations
While generally safe, a transbronchial lung biopsy carries some potential considerations. A primary concern is bleeding from the biopsy site, which is usually mild but can occasionally be more significant. Patients should monitor for increased or persistent coughing up blood or blood-tinged mucus, especially if it lasts longer than 24 hours.
Another consideration is pneumothorax, a collapsed lung, which occurs when air leaks into the space around the lung. Symptoms like new or worsening shortness of breath or chest pain after the procedure warrant immediate medical attention. Other signs include a fever above 100.4°F (38°C) or signs of infection at the insertion site, such as redness, swelling, or fluid leakage. While rare, cardiovascular events have been reported.