A lung biopsy is the most common procedure for lung cancer and other cancers in the chest. However, lung biopsy is also used in the case of pneumonia, tuberculosis and sarcoidosis. What are the indications and contraindications for a lung biopsy? What is this procedure? What complications may occur?

Lung biopsyis a procedure that involves taking cells or a piece of tissue (a section) of the lung for histological, cytological (smear) or microbiological examination to assess the nature of the lesions in the within the lung.

Depending on the method of pulmonary biopsy, the following are distinguished:

  • percutaneous lung biopsy - fine or large needle (TNB)
  • transbronchial lung biopsy (TBLB);
  • videothoracoscopy (VATS);
  • open lung biopsy (BOP);

Lung biopsy - indications

The indication for percutaneous lung biopsy is primarily lung cancer, especially one that cannot be diagnosed during bronchoscopy. The test is also performed if there is a tumor in the mediastinum (the space in the chest between the lungs), when it is suspected that the tumor has spread to the lungs from another organ (such as the breast), or if the tumor has not been clearly identified by a lump or infiltrate in the lung tissue. sputum or blood cultures, serology, or bronchoscopy. A percutaneous lung biopsy may also be ordered for changes in the pleura or the chest wall.

In turn, bronchial lung biopsy is used not only in the case of lung cancer, but also in other diseases, such as lung sarcoidosis, histiocytosis, tuberculosis, and pneumonia. This type of test is also performed after lung transplantation.

Videothoracoscopy is indicated in the diagnosis of pleural changes, e.g. pleural metastases, interstitial lung diseases.

An open lung biopsy is indicated primarily in the presence of diffuse lung lesions. However, due to the fact that it is the most invasive of all the above-mentioned procedures, it is performed when there are contraindications for biopsy using another method or when these methods make it impossible to makefinal diagnosis.

Lung biopsy - what is it?

1. Percutaneous lung biopsy (under the control of tk or X-ray)

A percutaneous fine needle biopsy is performed when the doctor wants to obtain material for a Pap smear. In turn,core needle biopsyis used to collect a piece of lung tissue for histological examination.

The doctor gives local anesthesia. It then visualizes the lung fragment to be punctured using X-ray, computed tomography or ultrasound. The patient holds his breath and the doctor inserts a special needle into the space between the ribs and sucks the cells (fine needle biopsy) or takes a lung section (core needle biopsy).

Immediately after the procedure and 24 hours after its completion, the patient should have a chest X-ray performed to exclude possible complications in the form of pneumothorax.

2. Transbronchial Lung Biopsy (TBLB)

First, the part of the lung from which the sample for testing will be collected is imaged (most often with the use of fluoroscopy, i.e. with the use of fluorescent materials). Thenbronchoscopyis performed. The doctor uses a flexible tube (bronchoscope) to insert special forceps into the respiratory tract (usually through the mouth), thanks to which he can cut off a small fragment of the lung flesh.

3. Video thoracoscopy (VATS)

An anesthesiologist gives general anesthesia. Then the doctor makes 2 to 4 incisions between the ribs and introduces special tools and a device containing a small camera through the chest wall. Thanks to it, he can carefully examine the surface of the lungs and take precise specimens for examination.

4. Open lung biopsy (BOP)

The patient is under general anesthesia. The surgeon then makes an incision in the chest wall and takes the appropriate piece of the lung for examination.

Important

Lung biopsy - complications

30% In cases, pneumothorax develops, which means the presence of air in the pleural cavity. It can also go to:

  • pulmonary air embolism;
  • bleeding into the pleural cavity;
  • hemoptysis;
  • neoplastic spreading in the puncture canal;

In a few cases (0.1%) the patient dies.

Lung biopsy - contraindications

  • percutaneous lung biopsy: severe COPD, pneumothorax, low platelet count (less than 50,000);
  • bronchial lung biopsy: blood coagulation disorders, pulmonary hypertension, fistulasarteriovenous, advanced emphysema;
  • videothoracoscopy: severe respiratory failure, advanced heart failure, decompensated coagulation disorders;
  • open lung biopsy: when it is possible to make a diagnosis using less invasive methods;

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Research