Lung biopsy

Lung biopsy options

Fine or core needle biopsy (also called a transthoracic needle biopsy):^1,2 The doctor inserts a fine hollow needle through the skin and chest wall to reach the nodule to test. Doctors often use CT scanning, ultrasound, or another imaging method to guide the needle into the nodule. If there are no complications, most patients go home within a few hours. Because the needle punctures the lung, air can leak out and cause the lung to collapse. About one in four people who undergo a needle biopsy experience a collapsed lung.

Manual bronchoscopy:³ The doctor inserts a flexible tube (catheter) with a camera. The catheter, less than one half inch (1 centimeter) wide and about 2 feet (60 centimeters) long, is inserted through your mouth and into your lung. Using images on a screen, your doctor manually guides the catheter to the nodule and extends a biopsy tool or needle to remove tissue samples. About 64% of lung cancers develop in the outer one-third of the lung.⁴

Ion robotic bronchoscopy: The Ion endoluminal system is robotic-assisted bronchoscopy for minimally invasive biopsy. As with conventional bronchoscopy, your doctor inserts a catheter through your mouth to your lungs. Ion uses an ultrathin catheter and GPS-like navigation. This gives your doctor the ability to steer through tiny, winding airways in the lungs’ outer edges.

Once at the nodule, your doctor guides the system to carefully remove a small amount of tissue from the nodule. Being able to collect tissue from small nodules anywhere in the lungs may help your doctor detect lung cancer at an earlier stage. In a study comparing biopsy with Ion to CT-guided needle biopsy, Ion had a comparable biopsy performance but a significantly lower rate of collapsed lung.⁵ Biopsies with the Ion system require general anesthesia. They are generally performed as an outpatient procedure. Outpatient means that you go home the same day.

Thoracoscopy or video-assisted thoracic surgery (VATS) biopsy:^6,7. After the patient receives general anesthesia, the surgeon makes small incisions and inserts a lighted tube with a camera between the ribs. The surgeon can use the camera to view the lung tissue, membrane (pleura) and fluid surrounding the lungs, and chest wall. The surgeon inserts instruments through the other incisions to remove samples for testing. Thoracoscopies may be outpatient or inpatient procedures. Inpatient means you will be admitted to the hospital for a stay of at least one night.

Open biopsy:^8,9 An open biopsy, also called surgical lung biopsy, is surgery that requires general anesthesia. The surgeon makes a cut in the skin (incision), separates the ribs to reach the lung, and removes tissue for testing.⁸ You may need to stay in the hospital overnight or longer following an open biopsy. Open biopsy is an invasive surgical procedure, so doctors usually prefer a less invasive biopsy approach, if appropriate.⁹

Is a lung biopsy a serious procedure?

Every procedure has risks, and every doctor’s experience is different. Talk with your doctor about whether you are a candidate for biopsy and which biopsy is best for you. Ask about:

• Complication rates of each of the biopsy approach options.
• Success in reaching small nodules in difficult-to-reach locations.
• How often they get a diagnosis based on the biopsy sample.

Lung biopsy preparation and recovery

How you prepare for a lung biopsy depends on the type you’ll undergo. The same is true for recovery. Be sure to ask your healthcare team for instructions on preparing for your lung biopsy and what you should know about your recovery. More information on preparing for an Ion robotic-assisted bronchoscopy procedure is available on the What to Expect page.

Biopsy results

Ask your healthcare team when you can expect the results of your biopsy. Your doctor may call to discuss your results or ask you to make a follow-up appointment to review them in person. The results may include one of the following findings:

• Benign: The nodule is not cancerous.
• Precancerous: This means that cells have grown abnormally to look different than normal cells. Often, these cells will stay the same or return to normal.
• Cancerous (malignant): Cancer cells were found in the biopsied tissue.
• Inconclusive: This result may occur if the tissue sample does not reveal a diagnosis. Depending on your situation, your doctor may suggest a period of watchful waiting or may want to perform a repeat biopsy.

The American Cancer Society’s Your Lung Pathology Report page, has additional in-depth information to help you understand your lung biopsy results.

1. Transthoracic Needle Biopsy. American Thoracic Society. Web. Accessed 4 June 2024.
2. Needle Biopsy of the Lung. Radiological Society of North America (RSNA) and the American College of Radiology (ACR). Web. Accessed 4 June 2024.
3. Bronchoscopy. Medline Plus. National Library of Medicine. Web. Accessed 3 June 2024.
4. Horeweg N , van der Aalst CM , Thunnissen E , et al . Characteristics of lung cancers detected by computer tomography screening in the randomized Nelson trial. Am J Respir Crit Care Med 2013;187:848–54.doi:10.1164/rccm.201209-1651OC
5. Yu Lee-Mateus A, Reisenauer J, Garcia-Saucedo JC, et al. Robotic-assisted bronchoscopy versus CT-guided transthoracic biopsy for diagnosis of pulmonary nodules. Respirology. 2023;28(1):66-73. doi:10.1111/resp.14368
6. Lung Cancer Diagnosis. American Lung Association. Web. Accessed 4 June 2024.
7. Thoracoscopy. American Cancer Society. Web. Access 5 June 2024.
8. Open lung biopsy. Medline Plus. National Library of Medicine. Web. Accessed 3 June 2024.
9. Modi P, Uppe A. Lung Biopsy Techniques and Clinical Significance. [Updated 2022 Jun 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.