If your doctor spots something out of the ordinary on your chest X-ray or CT scan, he may ask you to get a lung biopsy. In this procedure, a doctor removes a small sample of cells from your lung and checks it under a microscope for signs of disease.
You may also get a lung biopsy to help figure out why there's fluid in your lungs or to diagnose cancer. Whatever the reason, you may have lots of questions about how it's done and how to get ready. A lot depends on which type of lung biopsy your doctor recommends.
Bronchoscopy (Transbronchial Biopsy)
Your doctor puts a flexible tube that's about as wide as a pencil into your mouth or nose, and from there into your lungs. A light and camera help guide tiny tools that take cells from your lung out through the tube.
You'll be awake while this is going on, but you may get medication through an IV to help you to relax, as well as oxygen through a mask or nose tube.
To figure out the right spot to do the biopsy, your doctor may take an X-ray. Then he'll spray the numbing medication into your throat.
After he puts in the tube, you may feel uncomfortable in your throat, and you won't be able to swallow, but you'll be able to breathe. After it's over, you may have a sore throat, cough, or hoarseness that goes away in a few days.
Lung Needle Biopsy (Transthoracic Biopsy)
You usually get this type of lung biopsy when cells can't be reached with a bronchoscopy. Your doctor places a needle through your chest between two ribs to take a sample from the outer area of your lungs.
You'll be awake, and your skin will be numbed, and you may get a sedative to relax. To find the best place to do the procedure, you'll get an ultrasound, CT scan, or a particular type of X-ray known as fluoroscopy.
When the needle enters your lung, you may feel discomfort or pressure. You'll need to avoid coughing, and you may have to hold your breath.
Thoracoscopic Lung Biopsy (Thoracoscopy)
You may also hear your doctor call this a video-assisted thoracoscopic surgery (VATS). It checks for problems on the outside of your lungs.
You'll get general anesthesia for this procedure, which means you won't be awake for it. Your doctor puts a breathing tube down your throat and into your lungs and keeps tabs on your breathing, blood pressure, oxygen levels, and heart rate.
The doctor makes up to three small cuts on your chest between your ribs, then puts a thin, lighted tube with a camera on end and uses tiny tools to pull out some cells.
Open Lung Biopsy (Limited Thoracotomy)
Your doctor will usually only suggest this type of biopsy when other methods can't get cell samples.
As with a thoracoscopic lung biopsy, you won't be awake for this procedure. Your surgeon makes a more significant cut than in other methods, which may run from your chest and under your arms to your back. That lets your doctor reach your lungs and remove the cells.
How to Prepare for Your Lung Biopsy
To make sure a lung biopsy is safe, your doctor may suggest you get a full physical exam and blood tests. Let him know if you're pregnant or have any allergies, including to latex or drugs. Also let him know if you take medications, especially aspirin or other medicines that affect blood clotting.
You'll sign consent papers. Read them thoroughly to understand the procedure and risks.
Ask your doctor what to expect during the procedure. Some things to think about as you talk over the options:
If you get a bronchoscopy or needle biopsy, you'll recover faster. However, doctors remove fewer cells than with other procedures, which sometimes makes it more challenging to make a diagnosis
If you're getting a thoracoscopy or open biopsy, you can get the sample of cells tested right away. Depending on the results, your doctor can remove more samples, or even an entire lung, during the same surgery.
At least 8 hours before your lung biopsy, usually around midnight, you'll likely need to stop eating and drinking. If you are awake during the procedure, you may be able to drink water in the morning.
What Happens After Your Biopsy?
Your lung biopsy sample will be sent to a lab, and you'll get results within a week.
You may get a chest X-ray to make sure your lungs are working OK. If you weren't asleep, you should be able to go home after a few hours. Have someone pick you up because it's not safe to drive. Otherwise, you may need to stay in the hospital for one or more nights.
For the next few days, your chest may feel sore. If you have a wound from the procedure, follow your doctor's directions to clean it. You can usually go back to your normal activities but may need to avoid intense physical activity for several days. Only take pain medications your doctor prescribes, since some, like aspirin, can make you bleed more.
Risks and Complications
Pneumonia is a risk for all types of lung biopsies.
Pneumothorax, where air leaks out between the lung and chest cavity, can make it hard to breathe or cause your lung to collapse with these procedures, but your doctor will watch for this and suck out air as needed.
Other rare but severe complications of surgical lung biopsies may include severe bleeding, wound infection, and blood clots.
Call your doctor if you have any signs of infection or complications, which include:
- Fever over 100.4 F
- Redness, swelling, or blood or fluid leaking from the wound
- Severe chest pain
- Shortness of breath
- Coughing up blood or blood-tinged mucus