Lung Biopsy

A lung biopsy is performed if an abnormal tissue growth or an unusual lung condition is suspected. The process involves taking a small sample of a lung tissue and study it under the microscope to identify the actual problem.

The reasons for obtaining a lung biopsy could be:

  • a mass or nodule is suspected in the lungs or area surrounding the lungs
  • a lung infection is suspected which could either be viral, fungal or bacterial e.g. tuberculosis
  • to diagnose a lung disease (e.g. sarcoidosis, pulmonary fibrosis)
  • to determine the stage and type of a suspected or known lung cancer

Methods

There are 4 different ways of taking a small piece of the lung tissue depending on the location from where the sample is taken and the overall condition of a person’s health.

  • Bronchoscopic biopsy (Transbronchial biopsy): A procedure that involves viewing the lungs using a flexible camera (Bronchoscope) that is placed through the mouth or nose into the airways while you are sedated. A needle is then inserted into the abnormal tissue to remove a sample. This is recommended for a suspected infectious lung disease, lung tumour or enlarged lymph nodes. This procedure will be performed by you lung specialist (respiratory physician).
  • Needle biopsy (Transthoracic or Percutaneous biopsy): A procedure that involves using a needle inserted through the chest or back to remove a sample of the abnormal tissue in the lungs usually under CT or ultrasound guidance. This is recommended if the mass or the nodule is located near the chest wall, however, the sample taken may not be enough to make a diagnosis
  • Video-Assisted Thoracoscopic surgery (VATS): A procedure that involves using an instrument called a Thoracoscope (fiber-optic camera) which is inserted through a small incision on the side of the chest wall to visually examine the lung and remove a sample of lung tissue. One or two additional small incisions are used to insert instruments for obtaining the biopsy, such as a stapling device
  • Open surgical biopsy: An invasive method which involves surgery using an incision between the ribs on the side of the chest to remove a sample of tissue from the lung. This is recommended when a bigger sample is required for diagnosis or if other methods are unsuccessful or not recommended

Mediastinoscopy: A procedure involving a small incision at the base of the neck where a thin, hollow, lighted tube called a Mediastinoscope is inserted in front of the airway (trachea) to sample tissue from enlarged lymph nodes in the centre of the chest.

Risks

Possible complications will depend on the method used, the area where the tissue is located and your overall health condition. These would include:

  • Bleeding from the lungs
  • Collapse of the lung caused by air leak (pneumothorax)
  • Irregular heart rhythms
  • Impaired breathing
  • Infection
  • Pain
  • Reaction to anaesthesia

What to expect

It is standard procedure that you are asked to sign a consent form before anything is done to your body. Dr Orr will explain how the procedure is done, what will be its benefits, what the risks are and why is it needed.

You are asked to inform Dr Orr if you:

  • Have taken any medicines, which includes blood thinners (anti-coagulants) e.g. aspirin, warfarin (Coumadin) or clopidogrel (Plavix)
  • Are allergic to any medicines and anaesthetics
  • Have bleeding problems
  • Are pregnant

In preparation for the procedure, Dr Orr will ensure you undergo certain laboratory tests such as complete blood count (CBC) and clotting factors. You may have a pre-admission appointment one to two weeks beforehand, in which you will have routine blood testing and consultation with the anaesthesiologist. You will be advised at what time before the biopsy that you should stop taking any solid foods or fluids. Usually, it is 6 hours before the procedure.  If you are taking regular medication and they are to be continued on the day of your surgery, you can take them using with a sip of water.

Results

You will be informed of the results of the biopsy within 5-14 days. This may be while you are in hospital or at a follow-up appointment after discharge

Recovery

Follow an open lung biopsy, VATS or mediastinoscopy, you will be observed in the recovery room and your blood pressure, heart rate, respiration and oxygen saturations will be monitored. If there are no complications, you will be transferred to your room making sure that the chest tubes remain in place and on suction.

You may experience

  • Grogginess
  • Sore throat
  • Pain from the incision site

Inform the doctors if you have:

  • Uncontrolled pain
  • Light-headedness
  • Difficulty breathing
  • Feel unwell or nauseated
  • The Children's Hospital at Westmead
  • Heart Centre for Children- The Children's Hospital at Westmead
  • Sydney Children's Hospital Randwick
  • Westmead Hospital
  • Westmead Private Hospital
  • Royal Australasian College of Surgeons
  • International Society for Heart and Lung Transplantation
  • Sydney Adventist Hospital