Types of Lung Biopsy

A lung biopsy is a procedure to get a sample of suspicious lung tissue. By looking at the sample under the microscope, healthcare providers can better determine what exactly is causing an abnormality—and whether it is due to cancer or not.

A lung biopsy is also needed to determine the type of lung cancer, if present, as well as the molecular or genetic profile of the tumor.

Purpose of Lung Biopsy

There are several reasons a lung biopsy may be recommended:

• To evaluate a nodule or mass seen on an imaging study of the chest and determine if it is benign or malignant (cancerous)
• To follow up on abnormal results of computed tomography (CT) lung cancer screening
• To diagnose a bacterial, viral, or fungal lung infection
• To diagnose a lung disease such as sarcoidosis, pulmonary fibrosis, granulomatosis with polyangiitis, or rheumatoid lung disease
• To do genetic testing (molecular profiling) on lung cancer to look for mutations in cancer cells that "drive" growth, some of which can be treated with targeted therapies
• To determine the type of lung cancer
• To help determine the stage of known lung cancer

Different Lung Biopsy Procedures

Needle Lung Biopsy

In a fine needle lung biopsy, healthcare providers place a long needle through your back and into your lung to get a sample of tissue. This is done with the use of a CT scanner or ultrasound to help guide the needle to the appropriate location.

A needle biopsy is the least invasive way to sample a suspicious region in your lungs, but it does not always get enough tissue to adequately make a diagnosis. A needle lung biopsy is also called a transthoracic biopsy or a percutaneous biopsy.

Transbronchial Biopsy

A transbronchial biopsy is done during a bronchoscopy, a procedure in which a scope is directed down from your mouth and into the upper airways of your lungs.

With the help of an ultrasound (endobronchial ultrasound), physicians can then direct a needle into a suspicious area and obtain a sample (transbronchial needle aspiration.)

This procedure is most effective when an abnormality or tumor is located in or near the large airways of the lungs.

Thoracoscopic Lung Biopsy

In a thoracoscopic lung biopsy, a scope is introduced through the chest wall and into the region of the lung to be biopsied. A video camera is used to help healthcare providers find and biopsy the area of tissue.

In this procedure, also known as video-assisted thoracoscopic surgery (VATS), practitioners may also be able to remove an area of suspicious tissue or a lobe of the lung that is cancerous. (If this is planned, it will be discussed with you before the procedure.)

Open Lung Biopsy

As the most invasive way to sample tissue, an open lung biopsy is sometimes necessary to sample tissue when other methods have failed.

This is a major surgical procedure, done under general anesthesia. It may require separating the ribs or removing a portion of a rib to gain access to the lungs.

Sometimes, an open biopsy is performed as part of surgery to remove a nodule or mass, especially if your surgeon is quite certain that you have cancer.

Liquid Biopsy

A liquid biopsy is an exciting new area being studied to evaluate lung cancer. This procedure, requiring a simple blood draw, looks for circulating cancer cells in order to evaluate tumor DNA for driver gene mutations.

Sometimes when a lung biopsy is done, physicians are unable to extract enough tissue to perform this testing, and a liquid biopsy could make these results available without having to go after more tumor tissue.

The first liquid biopsy for detecting EGFR mutations in people with non-small cell lung cancer was approved in June 2016. In general, though, a tissue biopsy is still preferred in the majority of cases.

Results of Your Lung Biopsy

If your healthcare provider is able to get a good sample of tissue, you will likely hear about the results within two to three days. This may take longer, though, especially if more than one pathologist wishes to review the results.

It is helpful to ask your practitioner when and how you can expect to get your results. Some may require you to make a follow-up appointment so your results can be reviewed in person, while others may be comfortable calling you about the findings.

Though your healthcare provider may have a good idea of what the results will be, it’s not uncommon for physicians to be wrong after seeing a sample of tissue. The likelihood of an abnormality being cancerous depends on many factors, one of which is the size.

On occasion, a report may deem a biopsy "inconclusive." This means that the sample of tissue did not reveal a diagnosis. If that is the case, there are still several options.

• If the likelihood is low that the abnormality in your chest is cancer, you may opt to wait and do a repeat scan in a few months.
• If the spot may be cancerous but having a precise diagnosis wouldn’t alter treatment, you may opt to proceed with that treatment.
• If having a diagnosis will affect the treatment selected, you and your healthcare provider may choose to repeat the biopsy or find a different means of obtaining a tissue sample.

Molecular Profiling

It's important to note that everyone with non-small cell lung cancer should have gene testing (molecular profiling) done on their tumor. Raise this to your healthcare provider if it has not yet been discussed.

Currently, medications are approved for those with ALK rearrangements, EGFR mutations, ROS1 rearrangements, and other less common genetic alterations. Treatments for other targetable mutations are being done in clinical trials.

Risks

Needle biopsies are considered a very safe way to take a biopsy of the lungs when needed. Still, there are risks to be aware of.

The risks of a lung biopsy vary depending on the type of procedure, the location of the tissue, and your general health.

The most common complications are bleeding or an air leak from your lung. Other possible complications include:

• Pneumothorax: a collapse of the lung (air leak)
• Bleeding
• Infection
• Those related to anesthesia (whether local or general)
• Systemic air embolism, a leak of air into the major arteries that can travel to the heart (occurs in less than 1% of needle lung biopsies)
• Tumor "seeding": There is a risk that a tumor will spread along the track of the needle biopsy when a core biopsy is done. This is rare.

A Word From Verywell

Whatever the reason your healthcare provider has recommended a lung biopsy, waiting for the results can be difficult—but so too can foregoing the test and living in a state of never knowing.

Lean on your loved ones for support. If your mind goes to the worst-case scenarios, keep in mind that medicine is always changing. There were more new treatments approved for the treatment of lung cancer between 2011 and 2016 than during the 40 years preceding 2011.