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What is a Lung biopsy?

A lung biopsy is a procedure done under CT guidance to remove a small piece of a lung lesion or nodule with a needle so it can be examined with a microscope to determine the cause.

Why do I need to do this procedure?

You were diagnosed with a lung lesion or nodule. The only way to know why it has developed is to obtain a sample.

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There are several things that can cause a nodule in the lung. The most common causes are:

  1. Chronic Infection (fungus, TB)

  2. Acute infection (bacteria)

  3. Tumors (both benign and malignant)

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How the procedure is done:

 An IV will be inserted into one of your veins for access to give medications for moderate sedation.

  • You will lie on a CT table based on where your lung lesion is.

  • A low dose CT scan will be done where the lung lesion is to determine the safest access point.

  • Moderate sedation will be given through your IV to make you comfortable.

  • Procedure site will be cleansed and sterilized.

  • A medication to numb the area where the biopsy sample will be taken (local anesthetic) is administered.

  • A biopsy needle will be inserted into your lung. The CT scanner will be used to guide the needle to the lung lesion.

  • The needle will provide access to obtain multiple tissue samples

  • Sometimes a marker (fiducial) will be placed in case further localized treatment may be needed.

  • Needle will be removed and sterile skin glue will be applied to the puncture site.

  • A post-biopsy CT scan will be done to check for an air leak (lung collapse or pneumothorax).

  • If a pneumothorax is seen a small tube will be placed into the chest space (pleural space), but outside of the lungs, and attached to continuous suction to allow your lung to expand.

  • This can occur in about 10% of cases.

  • If no pneumothorax is seen then you will be taken to recover for 2 hours.

  • After 2 hours a chest X-ray will be done to make sure your lung does not have an air leak then you can go home.

What are the possible complications of a lung biopsy?

1. Air around the lung – also known as pneumothorax. This occurs because a small amount of air leaks out of the lung through the biopsy site and causes the air to be trapped between the lung and the chest wall. This causes the lung to collapse. Most of the time this happens within a few hours after the procedure and while it may cause no symptoms, it may require treatment. That is why we keep you in the recovery area after your biopsy for 2 hours and obtain a chest X-ray before you go home.

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If there is a small pneumothorax that is unchanged over several hours you will probably go home, but may need to return the next day for a follow up chest X-ray.

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Larger, or an enlarging pneumothorax requires placement of a small tube to remove the air that leaked. The tube usually will stay for 24-48hrs until that tiny hole seals. If you require a tube, you will stay overnight at the hospital while suction is used to continuously remove any additional air that collects.

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It is rare for a pneumothorax to develop after you are discharged. If you develop chest pain, shortness of breath, or a new cough, it may be a sign of a delayed pneumothorax and you should contact your interventional radiologists and/or go to the emergency room to have a chest x-ray.

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2. Bleeding: It is very common to have a little amount of blood in the sputum for up to a week after the procedure. However, it should not be more than a tablespoon. Severe bleeding is rare, but if that happens you need to contact your interventional radiologist emergently and seek immediate medical attention in the emergency room.

Care at the procedure site:

The procedure is performed through a small puncture, and often we place a small bandaid or skin glue. In either case, it is safe to shower the day after the procedure. If skin glue was used, it should fall off on its own in 1-2 weeks. You do not need to do anything.

When will the results of the biopsy be ready?

The results of the biopsy are usually ready in 2 business days. They will be forwarded to your physician who referred you to us. However, although some preliminary results are available in this time frame, in more difficult cases, additional tests may be necessary and may take several days. Sometimes, samples are sent for a second opinion at a separate institution (eg, Stanford, UCSF, Harvard or Mayo Clinic), which can also take a few days. Results looking for infection may take up to 4 weeks since some of the bacteria or fungi are extremely slow growing!

Can I get copies of the pathology reports and medical records?

Absolutely. All the medical records are yours ! You have the right to get a copy of all medical records, radiographic images, and pathology reports. Contact El Camino Hospital Medical Records at 650.940.7000.

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To get the radiographic images on a CD you should contact the radiology department at 650.940.7050.

Can we send the pathology samples to a second opinion at a separate institution?

Absolutely. In certain difficult cases the pathologists can consult with experts at the best institutions. However, most of the time this is not necessary. The El Camino Hospital Pathology team is extremely experienced. But if you want a second opinion you should contact the department of pathology at 650.940.7000.

When should you call your physician?

New shortness of breath or chest pain.
Severe lightheadedness and dizziness.
Coughing blood more than a tablespoon of pure blood.

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You can reach your Interventional radiologist at 650-404-8445

General Instructions:

Sedation

  • If you received sedation, you should not drive, consume alcohol, operate heavy machinery or make any important decisions for the remainder of the day.

Activity

  • You may resume your regular activities (including driving) after 24h, unless you have been restricted for another reason.

  • No exercising, lifting heavy objects or strenuous activity for the next 7 days.

Pain Management

  • Some pain or discomfort at the site of the procedure may be normal. However, it should not be getting worse.

  • It is also normal to have discomfort in the right shoulder area after the procedure, due to referred pain.

  • You may use over the counter medication such as Acetaminophen (tylenol) or Ibuprofen (Advil /Motrin) for minor discomfort, unless you are restricted from taking these medications.

  • Usually the pain is not severe and does not require stronger medications. If your pain is very severe it could indicate a bleeding complication or a pneumothorax. .

  • If you feel that Tylenol or Advil are not enough for pain control, please contact the Vascular and Interventional Radiology Clinic at 650-404-8445.

Diet

  • You can resume your normal diet. Some patients may develop nausea after the sedation. Therefore light meals are recommended until you know that you can eat without problems.

Cough

  • It is normal to have some cough and it is normal to have blood-streaked sputum for up to a week. However, a large amount of pure blood is abnormal and if it happens or is getting worse you should call your doctor or seek immediate medical attention. 

Shower

  • You can take a shower tonight. You should not soak the wound in water (eg. bath and swimming pool) for 1 week. 

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