What Is a Lung Biopsy?
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Medically reviewed by Angela Ryan Lee, MD
A lung biopsy is a procedure that involves removing a small tissue sample from the lung. An interventional radiologist (a doctor who specializes in procedures using medical imaging) usually performs the test and sends the tissue sample to the lab, where a pathologist (a doctor who specializes in examining body tissues) examines it under a microscope to look for signs of lung disease, such as cancer or infection.
Purpose
A lung biopsy is usually recommended after a chest X-ray or other imaging test reveals an abnormality in the lung. Your healthcare provider may recommend a lung biopsy to:
Investigate an abnormal finding, such as a nodule or mass, previously detected on a chest X-ray or computerized tomography (CT) scan to determine if it is benign (noncancerous) or malignant (cancerous)
Determine the stage and type of lung cancer
Diagnose bacterial, fungal, or viral lung infections
Diagnose lung disease, such as interstitial lung disease
Perform genetic testing on a tumor to look for specific genetic markers and make treatment decisions
Types of Lung Biopsies
There are several types of lung biopsies. The kind your healthcare provider recommends will depend on the location of the lung abnormality, the suspected lung condition, and your overall health.
Needle (Transthoracic) Biopsy
A needle lung biopsy is a minimally invasive procedure that involves inserting a long, thin needle through your chest wall to remove a small sample of lung tissue. Your healthcare provider will use a computed tomography (CT) scan or ultrasound scan to guide the biopsy needle into the correct location and obtain the tissue sample.
Transbronchial Biopsy
During a transbronchial biopsy, a tool called a bronchoscope—a thin, flexible tube equipped with a camera and light—is inserted into your nose or mouth and guided down to your airways. The bronchoscope also has small forceps that are used to remove lung tissue samples.
Thoracoscopic Biopsy
A thoracoscopic biopsy, or video-assisted thoracoscopic surgery (VATS), is used when more tissue is needed than can obtained from a needle or transbronchial biopsy. Your healthcare provider will make small cuts on your chest through which they insert a thoracoscope (a thin, flexible tube) and a small camera into the chest wall. The camera helps locate the lung nodule the tissue sample is taken from. Once they obtain the sample, they will place a drain in your lung to remove extra air or fluid.
Open Lung Biopsy
An open lung biopsy is the most invasive type, requiring a larger incision in the chest wall. You will receive general anesthesia, so you will be asleep during the procedure and not feel any pain. Once the incision is made, the surgeon will remove a tissue sample or samples from the suspicious area(s).
How Does It Work?
Before a lung biopsy, your healthcare provider will thoroughly evaluate your medical history and discuss the reason for the biopsy. They will also explain the procedure, discuss the risks and benefits with you, and answer your questions. You may need to sign a waiver demonstrating you understand the risks involved (e.g., infection, bleeding).
Before the Test
On the day of the procedure, you will need to avoid eating or drinking for six to eight hours before your appointment. Remember to provide information about your allergies, medications you're currently taking, and any existing health conditions you have so your healthcare team can ensure your safety during and after the procedure. Before the biopsy begins, you may need to change into a gown.
If you have a needle or transbronchial biopsy, you may take sedation medicine to make you feel sleepy and relaxed. Your provider will use local anesthesia to numb the area where they will insert the needle. If you have a thoracoscopic or open biopsy, you will be given light sedation or general anesthesia to help you relax. A tube is placed in your mouth and throat to help you breathe.
During the Test
Here's an idea of what happens during each type of lung biopsy:
Needle biopsy: A thin needle is inserted through your chest wall and into your lung. An ultrasound or CT scan are used to view your lungs to a tissue sample can be taken from the suspicious area or nodule. Once the needle is in place, your healthcare provider will remove a small tissue sample. The procedure typically takes about 30 to 60 minutes.
Transbronchial biopsy: During a transbronchial biopsy, a bronchoscope (thin, flexible tube) is guided through your nose or mouth and down into your lungs' airways. The bronchoscope has a camera so your healthcare provider can see the airways and lung tissue. Forceps on the end of the bronchoscope help remove small pieces of tissue from the lung. The procedure usually takes under 30 minutes.
Thoracoscopic biopsy: To perform a thoracoscopic biopsy, two small incisions are made in your chest wall. A thoracoscope (flexible tube equipped with a camera) is inserted through one incision so your surgeon can see your lungs and reach the right area. Surgical tools are inserted into the other incision to remove a piece of lung tissue. The procedure usually takes between 30 to 90 minutes.
Open biopsy: During an open biopsy, a larger incision is made on the left or right side of your chest to access the lungs. Your surgeon gently separates your ribs to access your lungs and remove tissue samples. The opening on your chest is closed with stitches, and a tube is placed near the incision site to drain excess air and fluid following the procedure. Most open lung biopsies take about an hour.
After the Test
Immediately following the lung biopsy, you will be monitored in a recovery area for about two hours. You should be able to go home after recovery for a needle or transbronchial biopsy. If you've had a thoracoscopic or open biopsy, you will stay in the hospital for a day or more for continued monitoring.
You should arrange for someone to drive you home, as you may be drowsy for up to 48 hours after the procedure. You may experience soreness at the biopsy site for a few days after a needle or transbronchial biopsy. If you had a thoracoscopic or open biopsy, you might have a scratchy throat or hoarse voice from the breathing tube during the procedure or discomfort on your chest at the incision site.
Your healthcare provider will give you instructions on caring for yourself at home after a lung biopsy. These instructions may include:
Avoid alcohol and smoking for 24 hours
Get plenty of rest
Avoid strenuous activity, including exercise and lifting heavy objects
Keep the biopsy site clean and dry
Risks and Precautions
As with any medical procedure, there are some possible risks associated with a lung biopsy, including:
Bleeding
Pain and discomfort at the biopsy site
Infection
Coughing up blood (hemoptysis) or blood-tinged mucus
Pneumothorax (a collapsed lung)
Air embolism (an air bubble that travels to the bloodstream and blocks a blood vessel)
A lung biopsy may not be safe for people with certain health conditions, such as:
Bleeding disorders
Emphysema with bullae (enlarged alveoli, which are the tiny air sacs in your lungs)
Lung cysts
High blood pressure in your lung arteries
Hypoxia (low oxygen)
After a lung biopsy, call your healthcare provider if you experience any of the following symptoms:
Fever
Chills
Shortness of breath
Severe chest pain
Blue-tinged skin
Coughing up blood or blood-tinged mucus
Redness, swelling, or fluid drainage at the biopsy site
Rapid heart rate
How to Prepare for Lung Biopsy
Preparing for your lung biopsy can help you feel emotionally and mentally ready and make the experience as smooth as possible. Your healthcare provider may ask you to stop taking certain medications, such as aspirin and blood thinners, for a few days before the procedure. This helps lower your risk of bleeding.
It is a good idea to bring a list of your allergies and any medications and supplements you're currently taking.
On the day of the procedure, your healthcare provider will ask you not to eat or drink for six to eight hours before the procedure. They may provide you with additional instructions, such as:
Shower the morning of the procedure
Do not wear makeup or perfume/cologne
Arrive at your appointment early so you have time to check in and prepare for the procedure
Bring your insurance card and photo identification to check in for your appointment. Most insurance plans cover the cost of a lung biopsy, but you may be responsible for a copay or deductible. Contact your health insurance provider to find out what your plan covers and what you can expect to pay out-of-pocket.
Interpreting Your Results
Your lung biopsy results, called a pathology report, may be available two days after the procedure, though some may take longer. Your healthcare provider may call with your results, or you may be able to view them through an online patient portal or mobile app. Some healthcare providers require a follow-up appointment to review your results in person.
Your pathology report will contain technical, medical terms that may be difficult to interpret. Your healthcare provider can explain the results and what they mean, answer your questions, and address your concerns. Though pathology reports can vary between healthcare facilities, they usually contain the following information.
Gross Information
This section includes how the tissue sample looked to the "naked eye" and details about the tissues the pathologist examined. Sometimes, biopsies involve removing more than one tissue sample, so details of each sample are listed within your pathology report.
Microscopic Information
This section shares what the tissue sample looks like under a microscope and how it compares to healthy cells. If cancer cells or markers of other lung diseases are detected, that information will be in this section.
Diagnosis
This section lists the pathologist's official diagnosis after carefully examining the tissue sample(s). Some diagnoses may be simple, such as a bacterial infection, including the specific bacteria causing the infection. When cancer is detected, this section may be lengthy and contain information describing the cancer type and tumor grade.
Synoptic Report
If cancer is the diagnosis, this section will include information about the cancer stage, the size of the tumor, and whether it has spread beyond your lungs.
Comments
If your biopsy results are inconclusive and the pathologist cannot provide a definitive diagnosis, they will explain why in this section and recommend additional testing. Sometimes, this happens if the tissue sample is too small or the cells in the sample need to be clearer to interpret accurately.
If the pathologist made a diagnosis, some pathology reports include information for you and your healthcare team, such as images, internet links to resources, and treatment recommendations specific to your diagnosis.
A Quick Review
A lung biopsy is a procedure to remove a small sample of lung tissue for examination under a microscope. Lung biopsies are used to diagnose lung cancer, autoimmune disorders affecting the lungs, or infection.
There are four main types of lung biopsy: needle biopsy, transbronchial biopsy, thoracoscopic biopsy, and open biopsy. Lung biopsies are generally safe procedures, but there are some possible risks to discuss with your healthcare provider. Your lung biopsy results are called a pathology report containing information about your diagnosis. Your healthcare provider will review your pathology report to help you understand what it means and discuss next steps.
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