What’s a lung biopsy?
A lung biopsy is the removal of a tissue sample from the lung. It is taken mainly by bronchoscopy (lung endoscopy), transthoracic (through the chest) fine needle biopsy or thoracoscopy (surgical procedure through the chest cavity) using a hollow needle or biopsy forceps. Which method is used depends on the location of the suspected area in the lung.
Indications for a lung biopsy
The general indication for a lung biopsy is the clarification of lung diseases that cause clinical symptoms and can be detected in a radiological procedure, but the cause is unclear. These include lung tumours, interstitial lung diseases (for example lung fibrosis), silicosis (occupational disease of the lung caused by quartz dust) or exogenous-allergic alveolitis (caused by organic dust).
Preparation before a lung biopsy
Before a pulmonary puncture, it is important to pay attention to blood clotting. The doctor in charge will discuss with you whether any anticoagulants are included in your medication that you take regularly and whether these can be taken further or have to be paused. As a rule, ASS can still be taken.
If you are taking ASA and clopidogrel in combination, it is usually recommended to pause clopidogrel 5 days before taking it. When taking Marcumar, the INR (a laboratory chemical blood value for blood clotting) should be checked. As a rule, the INR should be less than 1.5 for pulmonary puncture.
It should also be noted that painkillers in the NSAID group also have an anticoagulant effect. Aspirin and ibuprofen should therefore not be used for pain treatment if possible. In this case it is recommended to take paracetamol, which does not affect blood clotting.
You should be fasting on the day of the lung biopsy. This means that the last meal may be eaten the evening before the lung biopsy and only clear liquids such as water or tea may be drunk until about 4 hours before the biopsy. You can be given a sedative to calm you down before the lung biopsy. If necessary, you may be given some oxygen through a nasal cannula or, in case of coughing, cough-relieving medication.
Procedure of a lung biopsy
The procedure differs according to the methods used. Lung biopsy via bronchoscopy In a lung biopsy using bronchoscopy, the mouth and throat area is anaesthetised with a spray. If necessary, something can be given additionally for sedation.
The bronchoscope is inserted through the mouth or nose into the bronchial tubes. It consists of a tube with a camera at the end. There is also a working channel through which a tissue sample can be taken from the lungs using biopsy forceps.
The area is then rinsed with saline solution and aspirated. Lung biopsy via a transthoracic fine needle biopsy The transthoracic (through the thorax) fine needle biopsy is usually performed by a radiologist who works interventionally. It is performed in the prone position if possible.
The area to be punctured is sterilely covered and anaesthetised with a local anaesthetic. As a rule, the biopsy needle is inserted into the suspect region using an ultrasound machine or a CT. You will be asked to hold your breath during the puncture. After the procedure, an X-ray of the chest will be taken to rule out pneumothorax (air in the gap between the two lung skins) and bleeding.
Lung biopsy via thoracoscopy Thoracoscopy is one of the most minimally invasive surgical procedures. In a thoracoscopy, instruments and a camera are inserted through a small incision via the thoracic cavity. Tissue samples from the lung tissue can be taken through these instruments.
The area is then rinsed and suctioned. The incision is sutured and a bandage is applied. A drainage is also inserted for 1-2 days.
After the drainage has been removed, an x-ray of the chest is taken for control. Thoracoscopy is usually performed under general anesthesia. However, sedation is also possible.
- Lung biopsy via bronchoscopy In a lung biopsy using bronchoscopy, the mouth and throat area is anaesthetised with a spray. If necessary, something can be given additionally for sedation. The bronchoscope is inserted through the mouth or nose into the bronchial tubes.
It consists of a tube with a camera at the end. There is also a working channel through which a tissue sample can be taken from the lungs using biopsy forceps. The area is then rinsed with saline solution and aspirated.
- Lung biopsy via a transthoracic fine needle biopsy The transthoracic (through the thorax) fine needle biopsy is usually performed by a radiologist who works interventionally. It is performed in the prone position if possible. The area to be punctured is sterilely covered and anaesthetised with a local anaesthetic.
As a rule, the biopsy needle is inserted into the suspect region using an ultrasound machine or a CT. You will be asked to hold your breath during the puncture. After the procedure, an X-ray of the chest will be taken to rule out pneumothorax (air in the gap between the two lung skins) and bleeding. – Lung biopsy via thoracoscopy Thoracoscopy is one of the most minimally invasive surgical procedures.
In a thoracoscopy, instruments and a camera are inserted through a small incision via the thoracic cavity. Tissue samples from the lung tissue can be taken through these instruments. The area is then rinsed and suctioned.
The incision is sutured and a bandage is applied. A drainage is also inserted for 1-2 days. After the drainage has been removed, an x-ray of the chest is taken for control. Thoracoscopy is usually performed under general anesthesia. However, sedation is also possible.
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