What is a Lung Biopsy?

A lung biopsy is a medical procedure which involves removal of a small piece of lung tissue to examine it closely under a powerful microscope. Lung biopsy can be done in 4 different ways. However, the method used depends solely on the overall body health and the place of the lung where the sample is to be taken. The methods include:

• Needle Biopsy- In this procedure, a long needle is inserted through the wall of the chest to help remove a lung tissue sample. This procedure is mainly used if the suspicious abnormal lung is located near the wall of the chest. Imaging procedures such as ultrasound, computed tomography scan and fluoroscopy are used to guide the needle through the chest wall to the abnormal lung tissue.
• Open Biopsy- In this procedure, your surgeon will make an incision between your ribs and then remove a sample of your abnormal lung tissue. This procedure is exceptionally used when all other biopsies of the lung fail to give correct results or when a large piece of your lung tissue is needed for examination.
• Bronchoscopic biopsy- In this type of biopsy a lightened instrument commonly known as bronchoscope is inserted through the nose or mouth and then through the air way to extract a sample of your lung tissue. This type of biopsy is used when the lung is suspected to have an infectious disease or when the abnormality of your lung tissue is found next to the bronchi. This method can also be performed before trying any other invasive procedures such as open lung biopsy.
• Video-assisted thoracoscopic surgery (VATS) - A scope known as thoracoscope is used in this procedure to make an incision in the chest to help remove the abnormal bung tissue sample.

Reasons for doing lung biopsy

• It is done to diagnose some lung diseases and conditions such as pulmonary fibrosis or sarcoidosis. In some rare cases, lung biopsy may be done to diagnose pneumonia if its diagnosis is misleading.
• Can be used to detect suspected cancer of the lung
• Used in evaluation of lung abnormalities which can be seen in other tests such as CT scan and chest x-ray? Biopsy of the lung is used when all other tests fail to give information about the cause of your lungs problems.

How to prepare for a lung biopsy

These are the things you should do in preparation for your lung biopsy:

• Fill out a consent form to ensure that you understand how the procedure is performed and the possible risks associated with the procedure.
• Tell your doctor about any medications you take regularly such as NSAIDs and anticoagulants. These drugs include naproxen, aspirin and ibuprofen. You are required to stop taking the medications at least one week before the biopsy day. Other herbs and nutritional supplements such as fish oil should be discontinued as they would interfere with lung biopsy.
• Discuss with your doctor in case you have diabetes and you take insulin regularly.
• You should inform your health care professional if you are pregnant or expecting to be pregnant.
• Notify your doctor if you are allergic to anesthesia or other medications used during the surgery.
• Do not drink or eat anything 8–12 hours before biopsy. Clear liquids may be allowed in the morning of the procedure.
• Make arrangements for someone to drive you home after the procedure.
• Before undergoing a needle biopsy your doctor may give you a sedative to reduce pain during the procedure.
• Before an open biopsy of the lung, your doctor may introduce a general anesthesia intravenously into the vein of your arm. A thin tube connected to a breathing machine is also inserted though the windpipe to make sure you’re breathing properly during the procedure.

Special concerns you must know!

• You may need some blood tests, CT scan and/or chest X-ray scan before a lung biopsy.
• Biopsy of the lung is not recommended for patients with serious bleeding problems, pulmonary hypertension, heart disease, cysts or blisters on the lungs, abnormal lung blood vessels and respiratory insufficiency which can result from emphysema.
• Open biopsy may require injection of general anesthesia. Open biopsy is performed frequently compared to needle biopsy. It is suitable when all other less invasive biopsies give inconclusive results, when a lung lesion is large and requires complete removal, or when a large lung tissue sample is required for examination.

What to Expect

The major and commonly used biopsies of the lung include needle and open biopsy. Below are what you should expect during each of the procedures.

Needle Biopsy

• You will need to either lie down on your stomach/back or sit on a chair with your arms supported on a table. You should remain still throughout the procedure to avoid coughing which may cause a risk of damage of the lung with the biopsy needle.
• A local anesthesia will be injected on the site when the needle will be inserted to numb the cell and reduce pain during the procedure.
• A thin needle is inserted though the wall of the chest or through an incision made by use of a scalpel. CT scan or fluoroscopic imaging may be used to guide the biopsy needle to the abnormal lung tissue.
• You will be required to hold your breath when the needle is being inserted. After a sample tissue is removed the needle is withdrawn.
• To stop bleeding after the procedure, pressure is applied on the biopsy site.
• The whole procedure may take up to 30-60 minutes.

Open Biopsy

• During this procedure you will be required to lie on your back or side.
• An incision is then made on your chest and then a sample of your lung is taken by use of surgical instruments.
• A tube is placed on your chest for about 24 hours to help drain air and fluid out of the chest.
• An open biopsy of the lung may take 2-4 hours.

Risks and side effects

Possible complications common with lung biopsy include lung damage in needle biopsy, bleeding and infection of the biopsy site. Collection of fluid and air in the pleural cavity is common with lung biopsy. Other risks associated with lung biopsy include those caused by general anesthesia and sedation.

Bottom Line

Lung biopsy is a perfect procedure which can be used to diagnose any hidden condition in the lungs. After the tissue samples are taken by either open or needle biopsy, they are sent to a pathologist for physical examination. The samples may also be sent to a microbiologist for culturing of any infectious microorganisms. In general, lung biopsy results in a definitive diagnosis.