Lung needle biopsy

• Alternative Names

  Transthoracic needle aspiration; Percutaneous needle aspiration

• How the test is performed

  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.

  A needle biopsy of the lung may also be performed during bronchoscopy or mediastinoscopy.

  You sit with your arms resting forward on a table. You should try to keep still and not cough during the biopsy. The doctor will ask you to hold your breath. The skin is scrubbed and a local pain-killing medicine (anesthetic) is injected.

  The physician will make a small (about 1/8-inch) cut in the skin, and will insert the biopsy needle into the abnormal tissue, tumor, or lung tissue. A small piece of tissue is removed with the needle and sent to a laboratory for examination.

  When the biopsy is done, pressure is placed over the site. Once bleeding has stopped, a bandage is applied.

  A chest x-ray is taken immediately after the biopsy.

  The procedure usually takes 30 - 60 minutes. Laboratory analysis usually takes a few days.

• How to prepare for the test

  You should not eat for 6 - 12 hours before the test. Your health care provider may tell you to avoid aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, or blood thinners such as warfarin for a period of time before the procedure. Always 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. Sometimes, you will be given a mild sedative before the biopsy to relax you. You must sign a consent form. It is important to remain as still as possible for the biopsy and avoid coughing.

• 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 needle lung biopsy is performed when there is an abnormal condition near the surface of the lung, in the lung itself, or on the chest wall.

  The test is usually done to diagnose large abnormalities seen on chest x-ray or CT scan. Most often, the abnormality cannot be seen by other diagnostic techniques, such as bronchoscopy.

• Normal Values

  In a normal test, the tissues are normal and there is no 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)
  • Immune disorder
  • Pneumonia

  The test may also be performed for:

  • Metastatic cancer to the lung
  • Pneumonia with lung abscess
• What the risks are

  In a very small percentage of needle biopsies, a collapsed lung or pneumothorax occurs. Usually, chest x-rays will be done. However, if the pneumothorax is large, a chest tube may need to be inserted to expand (decompress) the lung.

  In rare cases, pneumothorax can be life threatening if air escapes from the lung, gets trapped in the chest, and presses on (compresses) the lungs and heart.

  Whenever a biopsy is done, there is a risk of excess bleeding (hemorrhage). Some bleeding is common, and a health care provider will monitor the amount of bleeding. Rarely, major and life-threatening bleeding may 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
  • Pulmonary hypertension
  • Severe hypoxia
• Special considerations

  Signs of a collapsed lung include:

  • Blueness of the skin
  • Rapid heart rate (rapid pulse)
  • Shortness of breath

  If any of these occur, report them to your health care provider immediately.

Review Date: 9/13/2008

Reviewed By: Benjamin Medoff, MD, Assistant Professor of Medicine, Harvard Medical School, Pulmonary and Critical Care Unit, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.