A tissue sample is extracted from the lung for laboratory analysis; the specimen is taken from an area that appears altered due to disease (lesion). Several techniques may be used, including needle biopsy, in which a long needle is passed through the chest wall and into the lung, and open biopsy, which accesses the lung surgically through a small incision. Tissue specimens may also be obtained by passing a tube like viewing instrument called an endoscope through the airways (bronchoscopy) or chest wall (thoracoscopy).
Purpose of the Lung Biopsy
- To confirm a diagnosis of lung disease, such as inflammatory conditions, infection, or cancer— especially after a chest x-ray, CT scan, and bronchoscopy have failed to provide a conclusive diagnosis
Who Performs It
- Needle biopsy is conducted by a physician assisted by a radiology technician.
- Open biopsy is performed by a chest surgeon and surgical team.
- This procedure is not appropriate for some patients with pulmonary hypertension or serious bleeding disorders, as well as those with lung cysts or blisters, lung blood vessel abnormalities, respiratory insufficiency (as may occur with emphysema), and some types of heart disease.
- Chest x-rays, a CT scan, and certain blood tests, such as coagulation studies, may be needed before the biopsy is done.
- Open biopsy, which requires general anesthesia, is performed less frequently than needle biopsy. It is generally done in cases where less invasive tests have been inconclusive, a large piece of tissue is needed to confirm a diagnosis, or the lesion is well-defined and may require complete removal.
Before the Lung Biopsy
- Tell your doctor if you regularly take anticoagulants or nonsteroidal anti-inflammatory drugs (such as aspirin, ibuprofen, or naproxen). You will be instructed to discontinue them for some time before the test. Also mention any herbs or supplements that you take.
- Tell your doctor if you are diabetic and are taking insulin.
- Tell your doctor all medications that you are taking, including supplements.
- Notify your doctor of any allergies and about your recent illnesses and other medical conditions.
- A women should inform her doctor if she is pregnant.
- Do not eat or drink anything for 8 to 12 hours before the procedure. (Sometimes clear fluids are allowed the morning of the test.)
- Arrange for someone to drive you home.
- At the testing facility, you will be asked to disrobe and put on a hospital gown.
- Before undergoing a needle biopsy, the doctor may give you a sedative, if necessary.
- Immediately before open biopsy, an intravenous (IV) needle or catheter is inserted into a vein in your arm, and you are placed under general anesthesia. A thin tube attached to a breathing machine is inserted through your windpipe to ensure you breathe properly during the procedure.
What You Experience
- You are asked to either sit with your arms supported on a table or lie down on your stomach or back. The doctor will advise you to remain still and avoid coughing during the procedure to reduce the risk of needle damage to the lung.
- The skin is scrubbed clean and a local anesthetic is injected to numb the area where the biopsy needle will be inserted. (You may still experience a pinching pain when the biopsy is taken.)
- The doctor inserts a thin biopsy needle through the chest wall into the lung (sometimes through a small incision made with a scalpel). Fluoroscopic imaging or CT scanning is used to guide the placement of the needle.
- You may be asked to hold your breath during needle insertion. A tissue specimen is obtained and the needle is withdrawn.
- Pressure is placed on the incision site until bleeding has stopped, and a small bandage is applied.
- The procedure takes 30 to 60 minutes.
- You are positioned on your back or side, and an incision is made in your chest.
- A portion of lung tissue is removed with surgical instruments, and the lung is sutured closed.
- A chest tube is left in place for about 24 hours, in order to drain fluid and air from the chest.
- An open lung biopsy can take 2 to 4 hours.
Risks and Complications
- Possible serious complications include bleeding in the lungs, infection, inadvertent needle-induced damage to the lung, or pneumothorax. (Pneumothorax, the collection of air in the pleural cavity that surrounds the lungs, always occurs after open biopsy. It is relieved by the chest tube left in place after surgery.)
- Open biopsy carries all the risks associated with general anesthesia.
After the Lung Biopsy
- You will remain in a recovery room for up to 3 hours after a needle biopsy; you may be hospitalized for 3 to 7 days after an open biopsy. During this time, your vital signs will be monitored and you will be observed for any signs of complications.
- You may be given pain-relieving medication to allay any discomfort around the biopsy site.
- You may cough up small amounts of blood temporarily. If it persists for more than 72 hours, notify your doctor.
- A chest x-ray is done after a needle biopsy to ensure that a pneumothorax has not developed.
- Arrange for someone to drive you home after you have recovered.
- Upon returning home after a needle biopsy, avoid strenuous activity for at least 24 hours.
- Go to the nearest emergency room if you experience chest pain or difficulty breathing.
- With an open lung biopsy, the doctor may be able to make a diagnosis by examining the structures in the chest.
- Tissue samples are sent to a pathology laboratory and examined under a microscope for unusual cells. They may also be sent to a microbiology lab and cultured for infectious organisms.
- This test usually results in a definitive diagnosis. Treatment will be initiated, depending on the specific problem.
The Johns Hopkins Consumer Guide to Medical Tests
Simeon Margolis, M.D., Ph.D., Medical Editor
Updated by Remedy Health Media