Test Overview

A lung
biopsy removes a small piece of lung tissue which can
be looked at under a microscope. The biopsy can be done in four ways. The method
used depends on where the sample will be taken from and your overall health.

  • Bronchoscopic biopsy. This type of biopsy uses a
    lighted instrument (bronchoscope) inserted through the mouth or nose and into
    the airway 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 breathing tubes (bronchi), or before trying more invasive methods, such as
    an open lung biopsy.
  • Needle biopsy. A needle biopsy uses a long needle
    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. A
    computed tomography (CT) scan, an
    ultrasound, or
    fluoroscopy are usually used to guide the needle to
    the abnormal tissue.
  • Open biopsy. An open biopsy uses surgery to make a
    cut (incision) between the ribs and remove a sample of lung tissue. An open
    biopsy is usually done when the other methods of lung biopsy have not been
    successful, cannot be used, or when a larger piece of lung tissue is needed for
    a diagnosis.
  • Video-assisted thoracoscopic surgery (VATS). VATS
    uses a scope (called a thoracoscope) passed through a small incision in the chest
    to remove a sample of lung tissue.

Why It Is Done

A lung biopsy is done to:

  • Diagnose certain lung conditions, such as
    sarcoidosis or
    pulmonary fibrosis. In rare cases, a lung biopsy may
    be done for severe
    pneumonia, especially if the diagnosis is not
    clear.
  • Diagnose suspected
    lung cancer.
  • Evaluate any abnormalities
    seen on other tests, such as a chest
    X-ray or a CT scan. A lung biopsy is usually done when
    other tests can’t identify the cause of lung problems.

How To Prepare

You will be asked to sign a consent form that says you understand the risks of the test and agree to have it done.

Talk to your doctor about any concerns you have
regarding the need for the test, its risks, how it will be done, or what the
results will mean. To help you understand the importance of the biopsy, fill
out the
medical test information form (What is a PDF document?).

Before you have a lung biopsy, tell
your doctor if you:

  • Are taking any medicines.
  • Are
    allergic to any medicines, including
    anesthetics.
  • Take a blood thinner, or if you have had bleeding problems.
  • Are or might be pregnant.

Your doctor may order certain blood tests, such as a
complete blood count (CBC) and clotting factors,
before your lung biopsy.

Your
doctor will tell you how soon before the biopsy to stop eating and drinking. Follow the instructions exactly
about when to stop eating and drinking, or your surgery may be canceled. If
your doctor has instructed you to take your medicines on the day of surgery,
please do so using only a sip of water.

Arrange to have someone drive you home after the
procedure if you do not need to stay in the hospital.

How It Is Done

A needle or bronchoscope biopsy can be done without staying in the
hospital. An open biopsy requires a hospital stay for at least a few
days.

You may be asked to remove dentures, eyeglasses or contact
lenses, hearing aids, a wig, makeup, and jewelry before the biopsy. You will
empty your bladder before the biopsy. You will need to take off all or most of
your clothes (you may be allowed to keep on your underwear if it does not
interfere with the biopsy). You will be given a cloth or paper covering to use
during the biopsy.

Bronchoscopic biopsy

A
bronchoscopic biopsy is done by a doctor who
specializes in lung problems (pulmonologist). It is usually done
using a thin, flexible bronchoscope. In rare cases, a biopsy may be done using
a rigid bronchoscope.

Bronchoscopy usually takes between 30 and
60 minutes. You will be in the recovery room 1 to 2 hours. A chest X-ray is usually taken after a lung biopsy to
look for any problems related to the biopsy.

Needle biopsy

A needle biopsy is done by a doctor
who specializes in X-ray tests (radiologist) or a pulmonologist. Your
doctor will use a CT scan, ultrasound, or fluoroscopy to guide the biopsy
needle. The place where your doctor inserts the needle is cleaned first with an
antiseptic solution and draped with sterile towels. Your doctor will give you a
local anesthetic to keep you from feeling any pain
when the needle is inserted into your chest.

Your doctor will then
make a small puncture and ask you to hold your breath while the biopsy needle
is inserted into your lung. It is very important to avoid coughing or moving
while the needle is in your chest.

Once the desired amount of
tissue is collected, the needle is removed and a bandage is placed over the
puncture site. You will need to lie on your side for at least an hour to allow
the needle puncture site to seal up.

This biopsy takes about 30 to
60 minutes. You will be in the recovery room 1 to 2 hours. A chest X-ray is usually taken after a lung biopsy to
look for any problems related to the biopsy.

Open biopsy and video-assisted thoracoscopic surgery (VATS)

An open biopsy is done by a
chest (thoracic) surgeon or a
general surgeon. You will be given a
general anesthetic by an
anesthesiologist. There may also be one or more
assistants in the room.

You will be given a
sedative to help you relax about an hour before the
biopsy. You will have an
intravenous line (IV) placed in a vein. A tube will be
placed in your windpipe (trachea) and a machine will help you breathe.

An incision is made between the ribs over the area of lung where the
tissue sample is to be collected. A scope called a thoracoscope may be passed
through this incision to view the surface of the lung and to remove a sample of
lung tissue. A larger incision will be made if an open biopsy is needed to
remove a tissue sample.

After the tissue sample is collected,
your doctor will insert a drainage tube (chest tube) into the area and close the
incision with stitches. One end of the tube will be in the space next to your
lung and the other end will be sticking out of your chest and connected to a
collection container. The chest tube helps re-expand your lung. The chest tubes
will be removed when the drainage from your chest has stopped and no air is
leaking from your chest incision, usually in a few days. Your stitches will be
removed in 7 to 14 days.

The entire biopsy usually takes about an
hour. After the lung biopsy is done, you will be taken to the recovery room for
about an hour. You will then be taken to your hospital room.

Recovery from a video-assisted thoracoscopic
surgery (VATS) takes less time than from an open biopsy surgery.

A chest X-ray is usually taken after a lung biopsy to
look for any problems related to the biopsy.

Video-assisted
thoracoscopic surgery (VATS) may not be available in your area. You may need to
travel to a regional medical center for this test.

How It Feels

Bronchoscopic biopsy

The local anesthetic used in
your mouth or nose generally tastes bitter and may make you choke. Your mouth
may feel very dry for several hours after the biopsy. You may also have a sore
throat and some hoarseness for a few hours. Sucking on throat lozenges or
gargling with warm salt water may help your sore throat.

The anesthesia may make it hard to swallow. You may need to avoid eating or drinking for at least an hour after the procedure.

You may
have a mild fever shortly after the biopsy, which usually goes away within 24
hours. If it does not, call your doctor.

Needle biopsy

When you are given the shot to numb
your skin at the needle biopsy site, you will feel a sharp stinging or burning
sensation that lasts a few seconds. When the needle is inserted into the chest,
you will again feel a sharp pain for a few seconds. The radiologist may ask you
to hold your breath for a few seconds at different times during the
biopsy.

Open biopsy

The sedative will make you feel sleepy
and relaxed. You will be asleep during the biopsy because of the general
anesthetic.

After the biopsy, you may feel tired for 1 or 2 days
or have general muscle aches. You may also have a mild sore throat from the
tube that was placed in your throat to help you breathe. Sucking on throat
lozenges or gargling with warm salt water may help your sore throat.

You may feel some discomfort at the biopsy site when you take a deep
breath. The incision may itch as it is healing. Your doctor will give you pain
medicine.

A bandage will be placed over the biopsy site. You
may be advised to keep the biopsy site covered and dry for 48 hours. You may
have a small amount of bleeding from the biopsy site. Ask your doctor how much
bleeding to expect.

Risks

A lung biopsy is generally a safe procedure.
Any risk depends on if you have a lung disease and how severe it is. If you
already have severe breathing problems, your breathing may be worse for a short
time after the biopsy.

Bronchoscopic and needle biopsies are
usually safer than open or VATS biopsies, but the VATS and open biopsies are
more likely to allow a good sample of lung to be removed. A good sample helps
determine what the lung problem is and what treatment choices are. Bronchoscope
or needle biopsies do not need general anesthesia, cause fewer problems, and
you do not need to stay overnight in the hospital. Your doctor will discuss any
risks with you.

  • Lung biopsy may increase your chance of
    developing a collapsed lung (pneumothorax) during the biopsy. Your
    doctor may need to place a tube in your chest to keep your lung inflated while
    the biopsy site heals.
  • Severe bleeding (hemorrhage) may
    occur.
  • An infection such as pneumonia may occur, but usually such
    infections can be treated with
    antibiotics.
  • Spasms of the bronchial tubes
    can occur, which can cause breathing difficulties right after the
    biopsy.
  • Irregular heart rhythms (arrhythmias) can
    occur.
  • People with severe lung disease have a very small chance of
    dying from the biopsy. But this is rare. If you receive general anesthesia,
    there is an extremely small chance of death from complications linked to
    general anesthesia.

After the biopsy

After a lung biopsy, call your
doctor immediately if you have:

  • Severe chest
    pain.
  • Lightheadedness.
  • Trouble
    breathing.
  • Excessive bleeding through the
    bandage.
  • Coughed up more than a tablespoon of blood.

Call your doctor if you have a fever.

Results

A lung
biopsy removes a small piece of lung tissue which can
be looked at under a microscope.

Lung biopsy results are usually
available in 2 to 4 working days. It may take several weeks to get results from
tissue samples that are being tested for certain infections, such as
tuberculosis.

Lung biopsy
Normal:

The lung tissue is normal under a
microscope. No signs of infection, inflammation, or cancer are present.

Abnormal:

Abnormal cells and tissue in the lung may
be due to active infection, certain lung diseases, or several different types
of cancer. If
lung cancer is present, results of the biopsy can
determine treatment options (surgery,
radiation, or
chemotherapy).

What Affects the Test

A biopsy sample that is too
small for a diagnosis can affect the accuracy of the results.

A
needle biopsy collects tissue from such a small area that there is a chance
that a cancer may be missed.

What To Think About

  • Before a final diagnosis is made, the results
    of a lung biopsy will be considered along with your past health, physical
    examination, and the results of other tests, including a chest
    X-ray or a
    CT scan. A bronchoscopy may also
    be helpful.

  • A lung biopsy may not be
    done for people who have:

    • Advanced lung disease, such as
      emphysema.
    • Bleeding disorders.
    • Heart failure, high blood pressure in the lungs
      (pulmonary hypertension), or enlargement of the right side of the heart (cor pulmonale).

References

Other Works Consulted

  • Pagana KD, Pagana TJ (2014). Mosby’s Manual of Diagnostic and Laboratory Tests, 5th ed. St. Louis: Mosby.

Credits

ByHealthwise Staff
Primary Medical Reviewer Adam Husney, MD – Family Medicine
E. Gregory Thompson, MD – Internal Medicine
Specialist Medical Reviewer David C. Stuesse, MD – Cardiac and Thoracic Surgery

Current as ofMarch 25, 2017