Lung Biopsy

Overview :

Overview

The lungs are a pair of cone-shaped organs that lie in the chest cavity. An area known as the mediastinum separates the right and the left lungs from each other. The heart, the windpipe (trachea), the lymph nodes, and the tube that brings the food to the stomach (the esophagus) lie in this mediastinal cavity. Lung biopsies may involve entering the mediastinum, as well as the lungs themselves.

Types of lung biopsies

Lung biopsies can be performed using a variety of techniques. A bronchoscopy is ordered if a patch that looks suspicious on the x ray seems to be located deep in the chest. If the area lies close to the chest wall, a needle biopsy is often done. If both these methods fail to diagnose the problem, an open surgical biopsy may be carried out. If there are indications that the lung cancer has spread to the lymph nodes in the mediastinum, a mediastinoscopy is performed.

NEEDLE BIOPSY. When a needle biopsy is to be done, the patient will be given a sedative about an hour before the procedure, to help relaxation. The patient sits in a chair with arms folded on a table in front of him or her. X rays are then taken to identify the location of the suspicious areas. Small metal markers are placed on the overlying skin to mark the biopsy site. The skin is thoroughly cleansed with an antiseptic solution, and a local anesthetic is injected to numb the area.

The doctor then makes a small cut (incision) about half an inch in length. The patient is asked to take a deep breath and hold it while the doctor inserts the special biopsy needle through the incision into the lung. When enough tissue has been obtained, the needle is withdrawn. Pressure is applied at the biopsy site and a sterile bandage is placed over the cut. The entire procedure takes between 30 and 45 minutes.

The patient may feel a brief sharp pain or some pressure as the biopsy needle is inserted. Most patients, however, do not experience severe pain.

OPEN BIOPSY. Open biopsies are performed in a hospital under general anesthesia. As with needle biopsies, patients are given sedatives before the procedure. An intravenous line is placed in the arm to give medications or fluids as necessary. A hollow tube, called an endotracheal tube, is passed through the throat, into the airway leading to the lungs. It is used to convey the general anesthetic.

Once the patient is under the influence of the anesthesia, the surgeon makes an incision over the lung area. Some lung tissue is removed and the cut closed with stitches. The entire procedure usually takes about an hour. A chest tube is sometimes placed with one end inside the lung and the other end protruding through the closed incision. Chest tube placement is done to prevent the lungs from collapsing by removing the air from the lungs. The tube is removed a few days after the biopsy.

A chest x ray is done following an open biopsy, to check for lung collapse. The patient may experience some grogginess for a few hours after the procedure. He or she may also experience tiredness and muscle aches for a day or two, because of the general anesthesia. The throat may be sore because of the placement of the hollow endotracheal tube. The patient may also have some pain or discomfort at the incision site, which can be relieved by medication.

MEDIASTINOSCOPY. The preparation for a mediastinoscopy is similar to that for an open biopsy. The patient is sedated and prepared for general anesthesia. The neck and the chest will be cleansed with an antiseptic solution.

After the patient has been put to sleep, an incision about two or three inches long is made at the base of the neck. A thin, hollow, lighted tube, called a mediastinoscope, is inserted through the cut into the space between the right and the left lungs. The doctor examines the space thoroughly and removes any lymph nodes or tissues that look abnormal. The mediastinoscope is then removed, and the incision stitched up and bandaged. A mediastinoscopy takes about an hour.