Lung needle biopsy

Definition

A lung needle biopsy is a method to remove a piece of lung tissue for examination. If it is done through the wall of your chest, it is called a transthoracic lung biopsy.

Alternative Names

Transthoracic needle aspiration; Percutaneous needle aspiration

How the test is performed

A chest x-ray or chest CT scan may be used to find the exact spot for the biopsy. If the biopsy is done using a CT scan, you may be lying down during the exam.

A needle biopsy of the lung may also be performed during bronchoscopy or mediastinoscopy.

You sit with your arms resting forward on a table. You should try to keep still and not cough during the biopsy. The doctor will ask you to hold your breath. The skin is scrubbed and a local pain-killing medicine (anesthetic) is injected.

The physician will make a small (about 1/8-inch) cut in the skin, and will insert the biopsy needle into the abnormal tissue, tumor, or lung tissue. A small piece of tissue is removed with the needle and sent to a laboratory for examination.

When the biopsy is done, pressure is placed over the site. Once bleeding has stopped, a bandage is applied.

A chest x-ray is taken immediately after the biopsy.

The procedure usually takes 30 - 60 minutes. Laboratory analysis usually takes a few days.

How to prepare for the test

You should not eat for 6 - 12 hours before the test. Your health care provider will likely tell you to avoid aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, or blood thinners such as warfarin for a period of time before the procedure. Always check with your health care provider before changing or stopping any medications.

Before a needle biopsy of the lung, a chest x-ray or chest CT scan may be performed. Sometimes, you will be given a mild sedative before the biopsy to relax you. You must sign a consent form. It is important to remain as still as possible for the biopsy and avoid coughing.

How the test will feel

You will receive an injection of anesthetic before the biopsy. This injection will sting for a moment. You will feel pressure and a brief, sharp pain when the needle touches the lung.

Why the test is performed

A lung needle biopsy is performed when there is an abnormal condition near the surface of the lung, in the lung itself, or on the chest wall. Most often, it is done to rule out cancer. The biopsy is usually performed after abnormalities appear on chest x-ray or CT scan.

Normal Values

In a normal test, the tissues are normal and there is no growth of bacteria, viruses, or fungi if a culture is performed.

What abnormal results mean

• Bacterial, viral, or fungal lung infection
• Cancerous cells (lung cancer, mesothelioma)
• Pneumonia

What the risks are

In a very small percentage of lung needle biopsies, a collapsed lung (also called a pneumothorax) occurs. A chest x-ray will be done after the needle biopsy to check for this. The risk is higher if you have certain lung diseases such as emphysema. However, if the pneumothorax is large, a chest tube may need to be inserted to expand your lung.

In rare cases, pneumothorax can be life threatening if air escapes from the lung, gets trapped in the chest, and presses on the rest of your lungs or heart.

Whenever a biopsy is done, there is a risk of excessive bleeding (hemorrhage). Some bleeding is common, and a health care provider will monitor the amount of bleeding. Rarely, major and life-threatening bleeding may occur.

A needle biopsy should NOT be performed if other tests show that you have:

• Blood coagulation disorder of any type
• Bullae (enlarged alveoli that occur with emphysema)
• Cor pulmonale
• Cysts of the lung
• Pulmonary hypertension
• Severe hypoxia (low oxygen)

Special considerations

Signs of a collapsed lung include:

• Blueness of the skin
• Chest pain
• Rapid heart rate (rapid pulse)
• Shortness of breath

If any of these occur, report them to your health care provider immediately.

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References

Ettinger DS. Lung cancer and other pulmonary neoplasms. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 201.