| A lung biopsy is a procedure that involves obtaining a tissue specimen from the lungs for microscopic analysis to establish a precise diagnosis. There are three types of lung biopsies. A needle lung biopsy, or percutaneous lung biopsy, is performed by passing a biopsy needle through the skin into the lung. A bronchoscopic lung biopsy is performed using a bronchoscope, and may require fluoroscopic (x-ray) guidance. An open lung biopsy is performed via a surgical incision in the chest. When the microscopic analysis involves lung tissue, it is referred to as histology. When the analysis involves cells from the lung, it is referred to as cytology.
Neither a needle lung biopsy nor a bronchoscopic lung biopsy should be performed if other tests indicate the presence of enlarged alveoli associated with emphysema (bullae), cysts, a blood coagulation disorder of any type, insufficient blood oxygenation (hypoxia), pulmonary hypertension, or enlargement of the right ventricle secondary to pulmonary hypertension that results from primary lung diseases (cor pulmonale, a type of heart failure). |
Source: Medical Disability Advisor
| A needle lung biopsy is performed when there is an abnormal condition near the surface of the lung, particularly in the tissues surrounding the lungs (parenchyma) or on the chest wall. The test can be performed to obtain a sample for culture when infection of the lung is suspected and sputum cultures have not identified the cause of the infection. The needle lung biopsy procedure is used to diagnose pneumonia, lung cancer, the spread of cancer throughout the body (carcinosis), lymphoma, and tuberculosis.
A bronchoscopic biopsy is performed to diagnose lung cancer, and diffuse or localized lung disease. The procedure is often performed when the abnormal tissue is in the larger airways (endobronchial) or deeper inside the chest, where a needle lung biopsy may be less successful.
An open lung biopsy or video-assisted biopsy is performed to determine whether a tumor is benign or malignant, or to determine the cause of diseases that affect the lung tissue. If a lung tumor is found to be malignant, biopsies of surrounding tissue and nodes are often performed to determine whether the cancer has spread (metastasized). These types of lung biopsies are usually performed after other methods have been inconclusive. |
Source: Medical Disability Advisor
| The needle lung biopsy is performed in a clinic on an outpatient basis. Often, a CT scanner will be used to precisely locate the tissue in question. The skin is scrubbed, and a local anesthetic is injected. A small (about 1/8-inch) incision is made in the skin, and the biopsy needle, which is attached to a syringe, is inserted into the abnormal tissue, tumor, or lung tissue. The biopsy needle has either a cutting tip or an aspiration tip. The cutting tip facilitates removal of a small sample of the suspected lesion, whereas the aspiration tip is equipped to "suck" cells from the lesion.
After a sample of lung tissue is obtained, pressure is applied over the site of the biopsy to stop bleeding; then, a bandage is applied. The procedure usually takes from 30 to 60 minutes; laboratory analysis usually takes a few days.
Bronchial biopsy is usually an outpatient procedure. An intravenous line may be established. Vital signs, electrocardiogram (ECG) tracings, and blood oxygen saturation are checked throughout the procedure. The individual is sedated and the upper airways are numbed using a local anesthetic. The fiberoptic scope (bronchoscope) is inserted through a nostril or the mouth, past the voice box (larynx), through the windpipe (trachea), and into a bronchus. In addition, local anesthetic may be applied through the bronchoscope to the air passages to suppress cough. The lung passages are viewed on a monitor. Instruments such as forceps, brushes, small cutting devices, or needles can be passed through to the bronchoscope to collect the tissue samples. Multiple specimens are usually obtained.
Fluoroscopic (x-ray) guidance may be used to biopsy lung tissue that is deeper in the lungs and not directly visible through the bronchoscope. If this procedure is performed, a chest x-ray is usually done following the procedure to look for evidence of pneumothorax, a potential complication.
The video-assisted lung biopsy (video-assisted thoracic surgery, or VATS) is performed in a hospital under general anesthesia. In the operating room, a camera is inserted into the chest cavity through a small incision. One or two more small incisions are made for the insertion of instruments. A small piece of lung tissue is removed. Usually a chest tube is left in the chest for a couple of days to prevent lung collapse.
The open lung biopsy procedure is done in a hospital operating room with the individual under general anesthesia. The skin is cleansed, the chest cavity is surgically opened, and a small sample of lung tissue is removed. The incision is closed with stitches. Some surgeons leave a chest tube in place, with one end inside the lung and the other protruding through the closed incision for 1 to 2 days to prevent the lung from collapsing.
Video-assisted or open lung biopsy is used when a needle lung biopsy is not appropriate, or when it is likely that the organ or tumor will require removal. Prompt analysis of the biopsy sample enables the diseased area to be removed immediately. |
Source: Medical Disability Advisor
| Lung biopsies generally provide reliable results in treatment, examination, and diagnosis when performed on easily accessible tumors. Needle biopsies are not as reliable in comparison with bronchoscopic biopsies, because a larger tissue sample can be obtained with the bronchoscope. For small nodules, open lung biopsy often provides the best results, but is a more involved procedure.
Abnormal results indicate the following possibilities: bacterial, viral, or fungal lung infection (for example, cytomegalovirus); cancer; immunoglobulin deposits (IgG, or rarely IgA) in the lung alveolar basement membranes (indicating immune disorders); or other inflammatory lung diseases. |
Source: Medical Disability Advisor
| Complications of the needle or bronchoscopic lung biopsy procedure include collapse of the lung (pneumothorax), which is due to leakage of air into the space between the lung and chest wall (pleural cavity), bleeding within the pleural cavity, and blockage of an artery by an air bubble (air embolism).
Complications of open lung biopsy or video-assisted biopsy include excessive bleeding (hemorrhage), infection, pneumothorax, air embolism, reactions to general anesthesia, or the creation of an abnormal opening (fistula) between the lungs and their surrounding membranes. |
Source: Medical Disability Advisor
| Moderate-to-heavy physical activity may need to be modified while the individual recovers from the lung biopsy procedure. The duration of the restriction will be greater for an individual who had undergone an open lung biopsy than for an individual who has undergone either a needle or bronchoscopic lung biopsy. |
Source: Medical Disability Advisor
| "Lung Biopsy." Yale New Haven Health. 21 May 2005 <http://yalenewhavenhealth.org/library/healthguide/en-us/medicaltests/topic.asp?hwid=support/hw232326>. |
Source: Medical Disability Advisor
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