Patient education: Lung biopsy (The Basics)

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What is a lung biopsy? — This is a procedure to check an abnormal area of the lung for cancer or other problems. People have 2 lungs, 1 on each side of the chest (figure 1). Each lung is surrounded by a thin layer of tissue called the "pleura." Some types of lung biopsies also look at the pleura.

You might get a lung biopsy if other tests, like X-rays and blood tests, show that there might be a problem with your lungs. A biopsy can help your doctor learn more about:

●What is causing your lung problems

●How serious your lung problems are

●Possible treatments

There are different ways to do a lung biopsy.

How do I prepare for a lung biopsy? — The doctor or nurse will tell you if you need to do anything special to prepare. Before your procedure, your doctor will do an exam. They might send you to get tests, such as:

●Blood tests

●Imaging tests like a chest X-ray or CT scan – These create pictures of the inside of the body.

Your doctor will also ask you about your "health history." This involves asking you questions about any health problems you have or had in the past, past surgeries, and any medicines you take. Tell them about:

●Any medicines you are taking – This includes any prescription or "over-the-counter" medicines you use, plus any herbal supplements you take. It helps to write down and bring a list of any medicines you take, or bring a bag with all of your medicines with you.

●Any allergies you have

●Any bleeding problems you have – Certain medicines, including some herbs and supplements, can increase the risk of bleeding. Some health conditions also increase this risk.

You will also get information about:

●If you need to stop taking any medicines for a time before the biopsy. Follow your doctor's instructions carefully to know which medicines are safe to take and which to avoid. Examples of ones you might need to stop include:

•Aspirin or aspirin-containing medicines

•Other nonsteroidal antiinflammatory drugs ("NSAIDs") such as ibuprofen (sample brand names: Motrin, Advil) or naproxen (sample brand name: Aleve). Many non-prescription medicines contain NSAIDs, so check the labels or ask your pharmacist for help.

•Medicines used to prevent blood clots, such as warfarin (brand name: Jantoven) or rivaroxaban (brand name: Xarelto)

•Certain medicines for heart conditions, such as dipyridamole (brand name: Persantine) or clopidogrel (brand name: Plavix)

•Certain natural products, such as fish oil or ginkgo biloba

●Eating and drinking before your procedure – In some cases, you might need to "fast" before the biopsy. This means not eating or drinking anything for a period of time. In other cases, you might be allowed to have liquids until a short time before the procedure. Whether you need to fast, and for how long, depends on the procedure you are having.

●What help you will need when you go home – For example, you might need to have someone else bring you home or stay with you for some time while you recover.

Ask the doctor or nurse if you have questions or if there is anything you do not understand.

What happens during a lung biopsy? — This depends on the type of biopsy you have. The choice is based on:

●Your health and any medical problems you have

●The size and location of the abnormal area

●What the abnormal area looks like with ultrasound or other imaging tests

When it is time for the procedure:

●You will get an "IV," which is a thin tube that goes into a vein. This can be used to give you fluids and medicines.

●The doctors and nurses will monitor your breathing, blood pressure, and heart rate during the procedure.

●For all biopsies, you will get anesthesia medicines. This is to make sure that you do not feel pain during the procedure. Types of anesthesia include:

•Local – This type of anesthesia uses medicine to numb a small part of your body so you don't feel pain.

•Regional – This type of anesthesia blocks pain in 1 area of your body, such as an arm, a leg, or the lower half of your body. If you get regional anesthesia, you might be awake. Or you might get medicines to make you relax and feel sleepy, called "sedatives."

•General – This type of anesthesia makes you unconscious so you can't feel, see, or hear anything during the procedure. If you have general anesthesia, you might get a breathing tube to help you breathe.

●The 4 main types of lung biopsies are:

•Percutaneous biopsy – "Percutaneous" means through the skin. This might also be called a "fine-needle biopsy" or "transthoracic needle biopsy." ("Transthoracic" means through the chest.) The doctor cleans and numbs the skin on the chest or back over the lung. They might use fluoroscopy (a type of moving X-ray) or a CT scan to guide them as they insert a needle to do the biopsy. They use the needle to remove a small sample of tissue from the abnormal area of the lung. Then, they remove the needle and hold pressure to stop any bleeding.

•Transbronchial biopsy – This is often used to look at areas deeper in the lung. The doctor uses a "bronchoscope," which is a thin tube with a camera on the end, to see inside the lungs (figure 2). The camera sends pictures to a screen that the doctor can see. They insert the bronchoscope through the nose or mouth and into the lungs. They might use fluoroscopy or other imaging tests to guide them as they take tissue samples.

•Thoracoscopic biopsy – This is also called "video-assisted thoracic surgery" ("VATS"). The doctor inserts an "endoscope" through a small cut (incision) in the chest wall. This is another thin tube with a tiny camera on the end. The camera sends pictures to a screen that the doctor can see. They can insert tools through the endoscope to take the tissue sample. They either control the tools directly or with the help of a robot. This is called "robotic-assisted thoracic surgery" ("RATS"). In some cases, they can also remove the abnormal area.

•Open lung biopsy – This is done in an operating room under general anesthesia. The doctor makes a small incision on the back or chest over the lung. Then, they take a sample of the abnormal tissue. When they are finished, they close the incision.

●After they are finished, the doctor will cover the area with a clean bandage.

●Most lung biopsies take about an hour.

What happens after a lung biopsy? — After your procedure, you might be taken to a recovery room. The staff will watch you closely as you recover. Depending on the type of biopsy you had, you might be able to go home the same day. Or you might need to spend the night in the hospital after the procedure.

As you recover:

●You will get a chest X-ray to make sure that you do not have a collapsed lung. When this happens, it is called a "pneumothorax."

●You will get medicine if needed to help with pain.

●You might have a chest tube in place for a day or so. This drains air and fluid from around your lungs.

What are the risks of a lung biopsy? — Your doctor will talk to you about all of the possible risks, and answer your questions. Possible risks include:

●Bleeding

●Infection

●Pneumothorax

●Injury to nearby organs

What else should I know? — Before you go home, make sure that you know what problems to look out for and when you should call the doctor. Make sure that you understand your doctor's or nurse's instructions. Ask questions about anything you do not understand.

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Patient education: Lung biopsy (The Basics)