Lung Biopsy

By Marty Polovich

(Biopsy-Lung, Closed Lung Biopsy, Transthoracic Needle Lung Biopsy, Percutaneous Needle Lung Biopsy, Transbronchial Lung Biopsy, Pulmonary Biopsy, Video-Assisted Thoracic Surgery, VATS)

Procedure Overview

What is a lung biopsy?

A biopsy is a procedure performed to remove tissue or cells from the body for examination under a microscope. A lung biopsy is a procedure in which samples of lung tissue are removed (with a special biopsy needle or during surgery) to determine if lung disease or cancer is present.

A lung biopsy may be performed using either a closed or an open method. Closed methods are performed through the skin or through the trachea (windpipe). An open biopsy is performed in the operating room under general anesthesia.

The various biopsy procedures include:

  • Needle biopsy - After a local anesthetic is given, the physician uses a needle that is guided through the chest wall into a suspicious area with computed tomography (CT or CAT scan) or fluoroscopy (a type of X-ray “movie”) to obtain a tissue sample. This type of biopsy may also be referred to as a “closed,” “transthoracic,” or “percutaneous” (through the skin) biopsy.

  • Transbronchial biopsy - This type of biopsy is performed through a fiberoptic bronchoscope (a long, thin tube that has a close-focusing telescope on the end for viewing) through the main airways of the lungs (bronchoscopy).

  • Thoracoscopic biopsy - After a general anesthetic is given, an endoscope is inserted through the chest wall into the chest cavity. Various types of biopsy tools can be inserted through the endoscope to obtain lung tissue for examination. This procedure may be referred to as video-assisted thoracic surgery (VATS) biopsy. In addition to obtaining tissue for biopsy, therapeutic procedures such as the removal of a nodule or other tissue lesion may be performed.

  • Open biopsy - After a general anesthetic is given, the physician makes an incision in the skin on the chest and surgically removes a piece of lung tissue. Depending on the results of the biopsy, more extensive surgery, such as the removal of a lung lobe may be performed during the procedure. An open biopsy is a surgical procedure and requires a hospital stay.

Other related procedures that may be used to help diagnose problems of the lungs and respiratory tract include chest X-ray, CT scan of the chest, magnetic resonance imaging (MRI), bronchoscopy, bronchography, chest fluoroscopy, chest ultrasound, lung scan, oximetry, mediastinoscopy, peak flow measurement, positron emission tomography (PET) scan, pulmonary function tests, pleural biopsy, pulmonary angiogram, sinus X-ray, and thoracentesis. Please see these procedures for additional information.

Anatomy of the respiratory system

The respiratory system is made up of the organs involved in the interchanges of gases, and consists of the:

  • Nose

  • Pharynx

  • Larynx

  • Trachea

  • Bronchi

  • Lungs

The upper respiratory tract includes the:

  • Nose

  • Nasal cavity

  • Ethmoidal air cells

  • Frontal sinuses

  • Maxillary sinus

  • Larynx

  • Trachea

The lower respiratory tract includes the lungs, bronchi, and alveoli.

What are the functions of the lungs?

The lungs take in oxygen, which cells need to live and carry out their normal functions. The lungs also get rid of carbon dioxide, a waste product of the body's cells.

The lungs are a pair of cone-shaped organs made up of spongy, pinkish-gray tissue. They take up most of the space in the chest, or the thorax (the part of the body between the base of the neck and diaphragm).

The lungs are enveloped in a membrane called the pleura.

The lungs are separated from each other by the mediastinum, an area that contains the following:

  • The heart and its large vessels

  • Trachea (windpipe)

  • Esophagus

  • Thymus

  • Lymph nodes

The right lung has three sections, called lobes. The left lung has two lobes. When you breathe, the air enters the body through the nose or the mouth. It then travels down the throat through the larynx (voice box) and trachea (windpipe) and goes into the lungs through tubes called main-stem bronchi.

One main-stem bronchus leads to the right lung and one to the left lung. In the lungs, the main-stem bronchi divide into smaller bronchi and then into even smaller tubes called bronchioles. Bronchioles end in tiny air sacs called alveoli.

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