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 4 ways. The method used depends on where the sample will be taken from and your overall health.

• Bronchoscope 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 an 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 thorascopic surgery (VATS). A VATS uses a scope (called a thorascope) 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 cannot identify the cause of lung problems.

How To Prepare

You will be asked to sign a consent form before a lung biopsy. Talk to your doctor about any concerns you have regarding the need for the biopsy, its risks, how it will be done, or what the results will indicate. 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 medications.
• Are allergic to any medications, including anesthetics.
• Have had bleeding problems or take blood thinners, such as aspirin or warfarin (Coumadin).
• Are or might be pregnant.

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

Do not eat or drink for 8 to 10 hours before the biopsy.

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

How It Is Done

You may be given some medications before the biopsy to dry up the secretions in your mouth and airways.

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, wigs, 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.

Bronchoscope biopsy

A bronchoscope 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.

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.

Open biopsy and video-assisted thorascopic 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 thorascope 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.

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

Video-assisted thorascopic 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

Bronchoscope 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.

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 medication.

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.

Bronchoscope 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. However, this is rare. If you receive general anesthesia, there is an extremely small chance of death from complications associated with general anesthesia.

After the biopsy

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

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

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 medical history, physical examination, and the results of other tests, including a chest X-ray or a computed tomography (CT) scan. A bronchoscopy may also be helpful. For more information, see the medical tests Chest X-ray, CT Scan, and Bronchoscopy.
• 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).
• Recovery from a video-assisted thorascopic surgery (VATS) takes less time than from an open biopsy surgery.

References

Other Works Consulted

• Handbook of Diagnostic Tests (2003). 3rd ed. Philadelphia: Lippincott Williams and Wilkins.

• Pagana KD, Pagana TJ (2006). Mosby’s Manual of Diagnostic and Laboratory Tests, 3rd ed. St. Louis: Mosby.

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