Lung biopsy, a diagnostic procedure in medicine, allows the removal of lung tissue. In studies such as histologic or genetic testing, the biopsy provides important information.
What is lung biopsy?
In a lung biopsy, lung tissue is removed and subjected to precise tests in a histopatologic or cytologic examination. In general, lung biopsy is an invasive diagnostic procedure. It is used in cases of diseases in the lung tissue where there are clinical symptoms visible on X-ray. A lung biopsy helps to diagnose pathological changes in the lungs. Lung tissue is removed and subjected to precise tests in a histopatological or cytological examination. More precisely, tissue or cells are removed from the body under a microscope. The samples are taken with a special biopsy needle or during surgery to rule out or confirm possible lung diseases or cancer. The form in which a biopsy is performed depends on various factors. The overall picture of the affected person’s disease is decisive, as well as where the lesion is located and which disease of the lung is present.
Function, effect, and goals
Lung biopsies are performed in what is called an open or closed procedure. In a closed procedure, the biopsy is taken through the trachea or skin. The open biopsy is performed in surgery under general anesthesia. In this procedure, an incision is made on the chest into the skin to surgically remove part of the lung tissue. According to the results of the biopsy, this procedure allows the surgeon to remove a lobe of the lung if necessary. Open biopsy is a major surgical procedure, so the patient must stay in the hospital after the procedure. In general, there are different procedures for tissue removal. Bronchoscopy uses a bronchoscope and biopsy forceps to remove tissue samples from accessible areas of the lung. The procedure is also possible in patients with severely impaired health. In this procedure, a long, thin tube is inserted, called a bronchoscope. Another procedure is transthoracic fine-needle biopsy, in which a tissue sample is taken under the control of computed tomography or fluoroscopy. This approach to biopsy is known as closed, transthoracic or percutaneous – through the skin – biopsy. In this procedure, a hollow needle penetrates the chest wall into the suspicious area. During penetration, ultrasound or CT is used for navigation. In the surgical procedure using local anesthesia, thoracoscopy is performed through a small step in the chest wall. In this procedure, the thorascope is inserted through the chest cavity, and the tissue is removed using biopsy forceps. However, only tissue that is on the surface of the lung is removed here. There is a risk of complications such as bleeding into the pleural cavity or pneumothorax. In direct vision, a biopsy is performed in a procedure called a thoracotomy by resecting the ribs, which is a surgical procedure on the chest. Complications are also possible in this case. However, the procedure of thoracoscopic biopsy can preserve the tissue, but also remove nodules or remove other tissue lesions. A lung biopsy also provides information about possible abnormalities, supports the diagnosis of infection in the lungs or lung disease. It provides a way to find causes to further clarify fluid accumulation in the lungs. The procedure is particularly important in determining whether the lung mass contains malignant or benign tumor cells. In addition, lung biopsy also allows a more accurate determination of how far a cancer has spread. Depending on the type of procedure, a drain may be inserted into the chest cavity to help drain fluid or air.
Risks, side effects, and dangers
Every surgical procedure is performed with the intention of restoring or improving the patient’s health. However, complications and discomfort can never be completely ruled out. Complications such as bleeding or pneumothorax can occur during a lung biopsy. Likewise, the patient has to follow the advice of his physician to positively influence his recovery.Special caution is required in the case of contraindications such as an increased tendency to bleed, but also in the case of thrombocytopenia or pulmonary hypertension. If interstitial lung disease is already present in patients whose vitality is severely reduced, or if non-compensable hypoxemia is present during oxygen administration, it must be weighed whether the risk of intervention by lung biopsy does not outweigh the benefit. Open or thoracoscopic lung biopsy may result in blood loss or blood clots. Also, the occurrence of pain or discomfort after the procedure cannot be ruled out, nor can pneumonia, pneumothorax, bleeding in the lungs, or infection. The physician should be aware of any pregnancy that may exist, although the risk of radiation exposure is not as great as with computed tomography or fluoroscopy. After general anesthesia, the patient remains in the recovery room until pulse, respiration, and pressure stability are stable and the patient is in good condition. If the biopsy was performed with local anesthesia, returning home to the usual environment is not a problem if the patient is in stable condition. In the following days, the patient must be patient and avoid physical exertion or sports activities for some time. In case of symptoms such as chest pain, coughing up blood, fever with or without chills, and breathing difficulties such as shortness of breath, consultation with the physician is recommended. If bleeding, swelling, or redness of the skin occurs around the biopsy site, medical follow-up is also advised.
