Lung Biopsy- Procedure and Recovery

Overview

Lung Biopsy is a procedure in which a sample of lung tissue is extracted and examined under the microscope. This will help confirm or rule out some lung condition so that the right treatment can be given. In this article, we will learn about the reasons for doing Lung Biopsy, types or methods of doing lung biopsy, how the procedure is done, and what are the risks associated with it.

Why is Lung Biopsy done?

• To investigate an abnormal finding during a chest X-ray or CT scan
• To diagnose certain lung infections and lung diseases
• To determine if a mass found in the lung is malignant (cancerous) or benign (non-cancerous)
• To determine the stage or spread of malignant tumour, either in the lung or surrounding organs (in case the cancer has metastasized)

Types of Lung Biopsy

There are various methods of extracting the lung-tissue sample. The technique used will depend on the overall health of the patient, the nature of lung condition, and its exact location within the lung. Accordingly, various types of lung biopsies have emerged over time.

Transbronchial Biopsy using Bronchoscopy

In this method, a flexible bronchoscope is pushed gently through the nose and mouth into the patient’s lungs. The doctors’ actions are guided by a camera and a light attached to the end of the tube. The patient will be awake but mildly sedated through an IV line, and oxygen supplied through a mask or nose tube. Numbing medication is applied in the nose and sprayed down the throat. An X-ray taken earlier will help the doctor decide the precise spot where the bronchoscope must stop. Brushes or other aids attached to the end of the scope help scoop up some lung tissue for examination. Once the procedure is over, the person may experience hoarseness, cough and sore throat for a few days.

Lung-needle Biopsy or Transthoracic Biopsy

Sometimes, a bronchoscope may not be able to reach the precise location and sample cells for examination. In such a case, the doctor will use a needle to extract lung tissue. First the patient is mildly sedated. Then using an CT scan, ultrasound the doctors will decide the precise location for sampling. Then the doctor will insert a needle in the chest between two ribs and sample some tissue from the outer part of your lungs. During the insertion and extraction of the needle, the doctor may advise the patient against coughing and advise holding of the breath for a few seconds.

Thoracoscopic Lung Biopsy or VATS

Also called Video Assisted Thoracoscopic Surgery (VATS). This procedure is done under general anaesthesia. First, the doctors will insert a breathing-tube down the throat and into the lungs. Vitals like oxygen, pulse, BP and heart-rate will be constantly monitored. Then the doctor will make 2 to 3 small cuts on the chest between the ribs, and insert a thin tube that has a light and camera at one end. Once the precise location is reached, tiny tools attached to the tube will pull out some cells from the outer layer of the lung(s) for examination.

Open Lung Biopsy or Limited Thoracotomy

When the doctors are sure none of the above methods will work, they will advise an incisional, or open-lung surgery in order to do a biopsy. The patient will be given general anaesthesia. Then using the most suitable method, the doctor will extract some lung cells for examination.

Preparing for the VATS and Open Lung Biopsy procedure 

• In case of a female patient, the doctor will ask the patient if she is pregnant. Next the doctors will explain the procedure in detail and answer any queries from the patient or family.
• The patient will be given a consent form to read thoroughly and then sign. In some cases, a lung biopsy may require a follow-up surgery during the procedure itself, then and there, once the biopsy results are checked. In such a case, the patient must be aware of it and give consent.
• The patient’s complete medical history will be checked and a thorough physical examination done. This may include blood and other diagnostic tests.
• The patient will be asked to list all medications being taken currently – allopathic or alternate medicines. A few days before the procedure, the patient must stop taking medications such as blood-thinners (aspirin, clopidogrel and warfarin).
• A few hours before the procedure, the patient must not eat or drink anything. In case there is some flexibility, the doctor will give clear instructions.
• The patient must remove and leave behind aids like dentures, contact lenses, bridges and glasses at home.
• The doctor will ask the patient about his/her allergies. More specifically to anaesthesia, iodine, tape or latex. This is based on previous experiences.
• The medical team will inject a sedative in the arm of the person. Then a numbing gel is rubbed inside the nose, and a numbing medication sprayed down the throat. All these helps reduce pain and discomfort.
• Based on the patient’s medical condition, any other preparation as required.

During the procedure for VATS and Open Lung Biopsy

Here the various steps involved, across the 4 types of biopsies. Some of them may not apply depending on which biopsy-type is performed.

• Excess hair at the site of incision is shaved off.
• An IV is connected to the arm to administer sedatives or medicines.
• The person is hooked up to instruments that monitor his/her vitals.
• A tube inserted into the lungs, and a ventilator, will help the person breathe.
• A urinary catheter may be inserted into the bladder to drain out urine during the procedure.
• The skin at the location of incision will be cleaned with an antiseptic solution.
• Once the ribs are seen, they are spread apart gently using a special instrument, leaving the lung exposed.
• The sample tissue is removed and, in some conditions, it is sent to a lab for quick examination. Once the results arrive, an extensive surgery may be required then and there.
• Once the procedure is over, tubes are inserted into the chest cavity to remove air or any fluids.
• The incision on the skin is closed using surgical staples or sutures. A sterile dressing or bandage is applied.
• Pain-killers are injected into the patient, and then he/she is wheeled out of the OT, and into the ward.

After the procedure

Once the person’s vitals are stable, he/she may be discharged in case of local anaesthesia. In case of general anaesthesia, he/she will stay in the hospital for a day. The nose and mouth will feel numb for a few hours in which duration, he/she is not allowed to eat or drink anything. Once the numbness goes away, he/she can consume soft foods like soups, porridges along with water and beverages like tea, coffee and milk. The nose and mouth will feel sore for a few days and the doctor may prescribe medicines to reduce pain or discomfort.

In case of transbronchial biopsy, the person will be asked to spit saliva into a basin, which will then be observed for traces of blood.

In case the person is experiencing any of these, he/she must call the doctor immediately: coughing up blood, shortness of breath, redness, bleeding, swelling or fluids oozing from the biopsy site, high fever, chills, difficulty in breathing or pain while breathing, and chest pain.

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Reviewed by Dr Suresh S Venkita, Group Medical Director, Kauvery Hospitals

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Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai, Hosur, Salem and Bengaluru, the hospital also renders adult and pediatric trauma care.

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