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Lung needle biopsy

Transthoracic needle aspiration; Percutaneous needle aspiration

 

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.

How the Test is Performed

 

The procedure usually takes 30 to 60 minutes. The biopsy is done in the following way:

  • 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.
  • You may be given a mild sedative to relax you.
  • A needle biopsy of the lung may also be done during bronchoscopy or mediastinoscopy.
  • You sit with your arms resting forward on a table. Your skin where the biopsy needle is inserted is scrubbed.
  • A local painkilling medicine (anesthetic) is injected.
  • The doctor makes a small cut in your skin.
  • The biopsy needle is inserted into the abnormal tissue, tumor, or lung tissue. A small piece of tissue is removed with the needle.
  • The needle is removed. Pressure is placed on the site. Once bleeding has stopped, a bandage is applied.
  • A chest x-ray is taken right after the biopsy.
  • The biopsy sample is sent to the lab. Analysis usually takes a few days.

 

How to Prepare for the Test

 

You should not eat for 6 to 12 hours before the test. Follow instructions about not taking aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, or blood thinners such as warfarin for a period of time before the procedure. 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.

 

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 done 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 done after abnormalities appear on a chest x-ray or CT scan.

 

Normal Results

 

In a normal test, the tissues are normal and there is no cancer or 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

 

Risks

 

Sometimes, a collapsed lung (pneumothorax) occurs after this test. A chest x-ray will be done to check for this. The risk is higher if you have certain lung diseases such as emphysema. Usually, a collapsed lung after a biopsy does not need treatment. But if the pneumothorax is large or does not improve, a chest tube is 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 too much bleeding (hemorrhage). Some bleeding is common, and a health care provider will monitor the amount of bleeding. In rare cases, major and life-threatening bleeding can 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)

 

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.

 

 

References

Ettinger DS. Lung cancer and other pulmonary neoplasms. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 197.

Silvestri GA, Jett JR. Clinical aspects of lung cancer. In: Mason RJ, Broaddus CV, Martin TR, et al, eds. Murray and Nadel's Textbook of Respiratory Medicine. 5th ed. Philadelphia, PA: Elsevier Saunders; 2010:chap 47.

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      Review Date: 8/25/2014

      Reviewed By: Denis Hadjiliadis, MD, Associate Professor of Medicine, Pulmonary, Allergy, and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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