Biopsy of the lungs

The removal of tissue from the lungs is relatively rarely used in the clinic as a diagnostic tool. It is an invasive, diagnostic procedure and offers the possibility to examine the lung cells histologically, immunologically or genetically for changes. The majority of all lung diseases can already be diagnosed by the clinical appearance of the patient and subsequent radiological imaging.

Only if the non-invasive methods cannot provide a reliable determination of the cause of the disease, a lung biopsy is necessary. These mainly include “interstitial” lung diseases and unclear tumours. A distinction must be made between whether the lung tissue itself, the vessels of the lung or the lung skin, the “pleura“, is affected.

The lung biopsy can then be performed in various ways. A fine needle biopsy is also possible. It is carried out without previous incisions.

The needle is inserted from the outside between the ribs through the thorax. The challenge here is to precisely hit the area to be examined. Ultrasound or CT can help here.

Another frequently used option is a biopsy during a bronchoscopy. The bronchoscope is used to examine the inside of the airways through the mouth. The infiltrate can be located and biopsied very precisely from the inside of the bronchial tubes using an integrated ultrasound probe.

Another very invasive method is the biopsy using thoracoscopy and thoracotomy. Here, an incision must be made to open the thorax in order to obtain samples directly from the lungs using forceps. This is usually done during large open operations.

Biopsy of the liver

A biopsy must be performed to clarify the cause of most tissue changes in the liver. The clinical picture and a radiological image usually precede this examination. A liver biopsy is mainly performed in the case of diffuse diseases of unclear origin, in the case of limited nodules that are conspicuous in the radiological image, and for the diagnosis of genetic diseases affecting the liver, for example haemochromatosis.

A punch biopsy is performed most frequently. In this procedure, ultrasound is guided between the ribs and a punch cylinder is removed. To keep the pain as low as possible, the patient is given a mild sedative and a local anaesthetic at the puncture site. In other cases, biopsies can be performed as part of open or laparoscopic surgery. Biopsies are necessary in the diagnosis of tumour diseases in order to determine the origin of the tumour or to establish whether it is a benign or malignant tumour.

Biopsy of the kidney

The biopsy of the kidney can be performed in cases of renal dysfunction that require a reliable diagnostic clarification. The main indication for such an examination is the “nephrotic syndrome“. This is a restriction of renal function characterized by a high excretion of proteins via the urine (proteinuria).

The renal corpuscles filter the blood so that in the end mainly water and salts remain. Proteins are usually completely retained in the blood. This can be caused by genetic and inflammatory kidney diseases, failed transplants or renal insufficiencies of any cause. The kidney biopsy is also performed using ultrasound and under local anaesthetic. On the basis of the fine tissue examination of the renal corpuscles obtained, a diagnosis can be made in some cases.