Lung Biopsy

What is a lung biopsy?

A lung biopsy is when a healthcare provider removes a small sample of tissue from your lung to examine under a microscope. Providers usually recommend it if they see signs of a lung condition (like a lung nodule) on an imaging test like an X-ray or CT scan. They most commonly use it to diagnose lung cancer. But it can diagnose other types of lung disease.

Another name for a lung biopsy is a pulmonary biopsy.

When is it performed?

Healthcare providers often suggest a lung biopsy if they notice a lung nodule after a screening test or an unrelated imaging test. They commonly use it to diagnose and stage lung cancer. But they may use it to diagnose other lung diseases, like:

• Sarcoidosis
• Pulmonary fibrosis
• Pneumonia (rarely)

How serious is a lung biopsy?

A lung biopsy is a relatively safe procedure. It’s usually minimally invasive. Most people go home on the same day as the procedure and recover relatively quickly.

How does a lung biopsy work?

In general, there are three approaches to a lung biopsy. Healthcare providers perform each type a little differently.

Bronchoscopy

During a bronchoscopy (transbronchial biopsy), providers guide a special tool through your nose or mouth, down your windpipe (trachea) and into your lungs to collect tissue. You’re under general anesthesia during the procedure.

Lung needle biopsy

Providers insert a thin needle between two of your ribs to remove tissue from the outside of your lungs.

What to expect before

A healthcare provider will explain the procedure and ask for your consent. They’ll perform a physical exam to ensure you’re healthy enough for surgery. They’ll also ask questions about:

• Your health history
• Any medications you’re taking (these include over-the-counter medications, prescription medications, vitamins and herbal supplements, which may increase your bleeding risk)
• Any allergies you have (these include any allergies to anesthesia, foods, latex, medications or skin cleaners like iodine or isopropyl alcohol)
• Whether you might be pregnant

They may also give you specific directions on:

• What (if any) medicines you should stop taking before the procedure
• Making sure to have a family member or friend to drive you home and help take care of you
• Whether you need to stop eating and drinking (fast) before the procedure

Food or drink in your stomach can increase your aspiration risk during the biopsy.

What happens during the procedure

During a lung needle biopsy, providers will:

1. Take X-rays or do a CT scan to see exactly where to perform the biopsy
2. Numb the area with a local anesthetic and possibly give you a sedative to help you relax
3. Clean your skin with a skin cleaner
4. Make a tiny cut between two ribs over your biopsy site
5. Insert the needle into the cut and guide it into your lung to collect a tissue sample
6. Remove the needle
7. Close the incision with stitches
8. Send your lung sample to a lab so a pathologist can look at it for signs of disease and help make a diagnosis

What to expect afterward

After a lung needle biopsy, you’ll move to a recovery room. Providers will monitor your overall health and manage your pain. They’ll also take chest X-rays to make sure your lungs are OK.

Once they determine you’re healthy enough, you can go home.

Open lung biopsy

During an open lung biopsy, a surgeon makes one cut (incision) in your chest that may run to your back. They remove a sample from this incision. This approach is rare. Providers only recommend it if they can’t get a sample from the other types.

Another name for an open lung biopsy is a limited thoracotomy.

What to expect before

Providers will explain the procedure and ask for your consent. They’ll check to make sure you’re healthy enough for surgery and that you have no bleeding or allergy risks. They’ll also give you specific directions on eating and drinking before the procedure and when to stop taking any medications. You must have someone available to drive you home and help take care of you for at least a few days.

What happens during the procedure

During an open lung biopsy, providers will:

1. Give you general anesthesia so you won’t be awake and won’t feel pain during the procedure
2. Put a breathing tube into your throat and hook you up to a ventilator to help you breathe (they’ll also monitor your vital signs)
3. Shave any body hair in the area and clean your skin with a skin cleaner
4. Insert a urinary catheter to drain pee from your urinary bladder
5. Make one long, single cut from your chest, under your arm and to your back
6. Use a tool to spread your ribs and access your lungs
7. Remove a tissue sample
8. Close the incision with stitches
9. Send your lung sample to a lab for testing

What to expect afterward

Providers will track your health and manage your pain in a recovery room. They’ll also encourage you to get out of bed and walk. Walking helps your body recover. It also helps reduce your risk of developing blood clots and pneumonia.

Most people need to stay at the hospital for at least one day after an open lung biopsy.

Thoracoscopic lung biopsy

A surgeon makes three small incisions in your chest between your ribs. They insert a thin tube with a camera at the end (thoracoscope) into one incision. In the others, they insert instruments to remove a sample.

Other names for a thoracoscopic lung biopsy include thoracoscopy and video-assisted thoracic surgery (VATS).

What to expect before

Providers will explain the procedure and ask for your consent. They’ll review your health history, ensure you’re healthy enough for surgery and check for any bleeding or allergy risks. They’ll give you directions on when to stop eating and drinking before the procedure. If you take medications, they’ll also tell you if you need to stop and when you can start again. Finally, they’ll ensure you have someone to take you home and help take care of you.

What happens during the procedure

During a thoracoscopic lung biopsy, providers will:

1. Give you general anesthesia so you won’t be awake or feel pain
2. Hook you up to a ventilator to help you breathe and monitor your vital signs
3. Shave any body hair in the area and clean your skin with a skin cleaner
4. Insert a urinary catheter to drain pee from your urinary bladder
5. Make a tiny cut between your ribs and one to two other cuts elsewhere in your chest
6. Insert a thoracoscope in the cut between your ribs to see and surgical tools in the other cuts to remove the tissue sample
7. Remove the thoracoscope and tools
8. Close the incisions with stitches
9. Send your lung sample to a lab for testing

What to expect afterward

You’ll move to a recovery room. Providers will track your health and manage your pain. They’ll also help you walk to help your body recover and reduce any post-surgery risks, like blood clots and pneumonia.

Most people need to stay at the hospital for at least one day after a thoracoscopic lung biopsy.

What are the risks of a lung biopsy?

Open and thoracoscopic lung biopsy risks include:

• Anesthesia problems
• Blood clots
• Healing problems
• Infection
• Scarring

Bronchoscopy and lung needle biopsy risks include:

• Bleeding in your lungs (pulmonary hemorrhage)
• Collapsed lung
• Infection

What happens if a lung biopsy is positive?

If your lung biopsy results are positive, that means you have a condition that affects your lungs. Healthcare providers may recommend more tests, like:

• Imaging tests to see if lung cancer has spread — including a bone scan, CT scan, MRI, PET scan or ultrasound
• Pulmonary function testing to see how well your lungs work
• Tumor markers to learn more about the type of lung cancer

Your test results can help your providers figure out the best treatment plan for you.

What percentage of lung biopsies are cancerous?

If a healthcare provider notices a lung nodule in an imaging test, keep in mind that the odds of it being lung cancer are low. Only about 3 or 4 in 100 lung nodules are cancerous.

When should I know the results?

It usually takes a few business days to get your results. But it may take up to 10 days. A healthcare provider will give you a better idea of when to expect your results.

When should I call my doctor?

After a lung biopsy, call a healthcare provider if you:

• Cough up blood
• Have problems breathing
• Have severe chest pain
• Have signs of an infection

How invasive is a lung biopsy?

It depends on the type. Bronchoscopy and lung needle biopsy are minimally invasive procedures. An open lung biopsy and thoracoscopy are more invasive, use general anesthesia and take longer to heal.

How long does it take to recover?

It depends on the type of procedure. Bronchoscopy and needle biopsy usually only take about one day to recover. But you should take at least two days off school or work. Other types may take longer. Your healthcare provider will give you a better idea of what to expect.