Lung Biopsy & How is it Done

What is a Lung Biopsy?

A biopsy is a test in which a small piece of tissue is taken by various methods to be examined by a pathologist or microbiologist to confirm a diagnosis. So, a lung biopsy is a test to take a small piece of a lung and is done to look for lung disease, cancer, or another condition.

There are several methods of performing lung biopsy. The exact method chosen depends on several factors, such as the location of the lung abnormality, the desired amount of tissue required, the condition of the lungs, and the patient’s condition. In this blog, we will discuss the various methods of lung biopsy and who needs it. 

How is Lung Biopsy Performed? 

There are several types of lung biopsy:

• Needle biopsy. In this method, a needle is used to remove a small portion of lung tissue. It is done under local anaesthesia, wherein a numbing medicine (local anaesthetic) is administered at the site of the biopsy. A specialised needle (Tru-cut) is put into the target lung tissue to take out a core of tissue sample. This kind of biopsy is almost always done under the guidance of an imaging modality like ultrasound or CT scan. The imaging modality helps the doctor precisely guide the needle to the target lesion, increasing the chance of good yield and decreasing the chances of injuring adjacent structures. This type of biopsy is called a closed, transthoracic, or through-the-skin (percutaneous) biopsy.
• Transbronchial biopsy (Bronchoscopy)- This type of biopsy is done with a bronchoscope. This is a long, thin tube with a tiny camera. The bronchoscope is put down the throat and through the windpipe (trachea) down into the main airways of the lungs. Forceps are used to remove very small pieces of the lung. This is usually done under sedation to make the patient comfortable. 
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• Thoracoscopic biopsy- In some cases the target abnormality in the lung may be located in a place where needle biopsy or bronchoscopic biopsy may not be feasible due to proximity to vital structures like large blood vessels or heart. Sometimes, a larger sample in the form of an entire nodule may be required if attempts at needle / bronchoscopic biopsies have failed to give a result.  Such patients may require a surgical biopsy. This is a short surgery done under full general anaesthesia. In experienced centres, this is done by the minimally invasive Thoracoscopic (keyhole) method. This is also called a video-assisted thoracoscopic surgery (VATS) biopsy. This procedure can be done with a therapeutic intent wherein the abnormal nodule is totally removed. This may require the removal of a small portion of lung (segmentectomy)  or a bigger part of the lung (Lobectomy).

• Open biopsy. This is again done under general anesthesia. This method is used if the sample from the needle biopsy is too small to get a diagnosis and minimally invasive options are not possible. A cut (incision) in the skin is made to get to the lung. A piece of the lung is removed. Depending on the fast results of a biopsy, more surgery may be done during the test. This may include removing a wedge or a lobe of the lung. An open biopsy is a more morbid procedure and is not routinely employed. 

Who Needs a Lung Biopsy ? 

A lung biopsy may be done to:

• Check an abnormal spot (Lung Nodule) on the lung seen on a chest X-ray or other imaging test
• To diagnose lung infection or other lung disease like tuberculosis, fungal infection (Mucormycosis also known as Black fungus) 
• Find out if a lung tumor is cancer (malignant) or not cancer (benign)
• To diagnose and characterise Interstitial Lung Disease. 

What are the Risks of a Lung Biopsy?

The risks of a lung biopsy may include:

• Blood loss or blood clots
• Pain or discomfort
• Infection
• Pneumonia
• Problems from general anesthesia
• Air in the space between the lung and the inner chest wall (pneumothorax)
• Fluid in the space between the lung and the inner chest wall (pleural effusion)

Your risks may vary depending on your general health, the type of biopsy, and other factors. Ask your healthcare provider which risks apply most to you. Talk with them about any concerns you have.

How to prepare for a Lung Biopsy? 

Discuss the need for a lung biopsy with your healthcare provider. Openly discuss your concerns, risk factors and alternative options if any. You will be asked to sign a consent form that permits you to do the test. Read the form carefully. Ask questions if anything is not clear.

You must inform your doctor If you: 

• Are pregnant or think you may be pregnant
• Have any allergy to contrast dye or iodine (based on previous tests)
• Are allergic to any medication or substance including latex gloves, tapes etc. 
• Take any medicines, including prescriptions, over-the-counter medicines, vitamins, and herbal supplements
• Have had a bleeding disorder
• Take blood-thinning medicine (anticoagulant), aspirin, or other medicines that affect blood clotting like clopidogrel, rivaroxaban, apixaban, heparin, warfarin etc.  

You must make sure to:

• To withhold certain medications before the test, if advised by your doctor.
• Keep yourself empty stomach for at least 4 hours  or as advised by your doctor. 
• Keep an adult family member or friend with you. 
• Follow all other directions your healthcare provider gives you

What Happens after a Lung Biopsy?

After the test, you will be kept under observation for some time in a recovery room. You may be sleepy and confused when you wake up from sedation or  general anesthesia. A close monitoring of your vital signs, such as heart rate, breathing and oxygen saturation is done. 

Usually, a chest X-ray is done after the test and may be repeated in a few hours to make sure your lungs are OK.

In case you had undergone a biopsy using a bronchoscope, you may have some throat discomfort. No oral intake is allowed until your gag reflex has returned. Some throat soreness and pain with swallowing for a few days is usually normal. 

If you had an outpatient test, you will go home when your healthcare provider says it’s OK. Someone will need to drive you home.

There may be some soreness at the biopsy site for a few days. After the procedure, you should carefully follow the advice given by your doctor. Follow all instructions your healthcare provider gives you for wound care and bathing. 

Return to normal activity at home, like bathing, should be based on the advice of your doctor. It is best to avoid any strenuous work for 4-5 days after the biopsy. 

Please look for any warning signs and consult your doctor immediately if you have any of the below:

• Fever of 100.4°F (38°C) or higher
• Chills
• Difficulty in breathing or Shortness of breath
• Chest pain
• Pain with breathing
• Coughing up a lot of blood
• Redness or swelling of the biopsy site or incisions
• Blood or other fluid leaking from the biopsy site or cuts