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How Your Doctor Uses Biopsies to Make a Diagnosis of Lung Cancer

Your doctor may suggest that you have one or more of the following procedures to help make the diagnosis of lung cancer. After any kind of biopsy, a specialized doctor, called a pathologist, looks at the tissue samples under a microscope to check for cancer cells. It usually takes several days for the results of your biopsy to come back. A biopsy is the only sure way to tell if you have cancer and what kind of cancer it is.

There are several ways your doctor can take a biopsy of your lung, including:

  • Bronchoscopy

  • Needle biopsy

  • Thoracentesis

  • Thoracotomy or thoracoscopy 

Each is described below.

Bronchoscopy

This biopsy is usually done by a doctor called a pulmonologist who specializes in lungs. To get the cells for this type of biopsy, the doctor uses a long, thin, lighted tube called a bronchoscope. It may be flexible or rigid. The tube goes through your mouth or nose, into your breathing passages, and into the lungs. It has a tiny camera on the end so that your doctor can see inside your lungs to get the cells.

Here’s what to expect during a bronchoscopy

You will need to stop eating for six to 12 hours before the test. The biopsy may take about one hour. Here’s what happens if your doctor is using a flexible bronchoscope. Your doctor sprays a local anesthetic inside your nose or mouth to numb the area. You may feel as if fluid is running down your throat. It may make you cough or gag. That feeling will stop when the anesthetic takes effect and numbness kicks in. You may also have an IV with medication to help you relax.

If your doctor uses a rigid bronchoscope, you will need to be put to sleep by receiving a general anesthetic.

With either type of bronchoscopy, your doctor uses a saltwater solution called saline. This liquid flushes the area and helps collect cells, fluids, and other materials in your airways. Your doctor may also put tiny brushes, needles, or forceps through the bronchoscope to collect cells from any suspicious-looking areas. He or she will send all the collected samples to a lab to be checked for cancer.

As the anesthetic wears off, your throat may feel scratchy. You won’t be able to eat for several hours. You may need to stay in the hospital overnight. You won’t be able to drive yourself home, so you will need to arrange for transportation. Some people want to rest the day after the biopsy. So you may want to take the day off from your usual activities and arrange for child care, if necessary.

Needle biopsy

This is also called needle aspiration or transthoracic needle aspiration. Your doctor may use this procedure if your tumor can’t be reached easily by a bronchoscope. The doctor inserts a hollow needle through your chest and into the tumor to remove some tissue. Often, you will be having an X-ray or CT scan at the same time. That helps the doctor see the tumor and guide the needle. 

Here’s what to expect during a needle biopsy 

This procedure takes about 30 to 60 minutes. It’s usually done by a doctor called an interventional radiologist. You may have a chest X-ray or a chest CT scan to help your doctor see exactly where to take the cells. If you are getting an X-ray, you will sit with your arms resting on a table. If you’re getting a CT scan, you’ll be lying down. In either case, it’s important that you don’t move. You may get a mild sedative to help you stay still. The doctor numbs your skin by injecting a local anesthetic. To get the needle in, the doctor may need to make a very small cut in your skin. You will feel pressure and a short, sharp pain when the needle touches your lung. The needle goes into the tumor or abnormal tissue and draws out cells. The doctor applies pressure until the bleeding has stopped and then covers the site with a bandage. The doctor sends the collected cells to a lab to be checked for cancer. Immediately, after the biopsy, you’ll have a chest X-ray. This is to make sure there are no complications, such as a collapsed lung called a pneumothorax. You can probably drive home yourself.

Thoracentesis

This is also called a pleural fluid aspiration or a pleural tap. To get the cells for this type of biopsy, the doctor uses a needle to take some fluid from around your lungs. Normally, there is very little fluid in this area. This procedure may be done to make a diagnosis of lung cancer. It is also a procedure that is done to drain fluid if it is making you short of breath.

Here’s what to expect during a thoracentesis

You will lie on a bed. Or you may sit on the edge of the bed or a chair and rest your head and arms on a table. The doctor injects a local anesthetic into your skin on your chest or back to numb the area. Then, the doctor inserts the thoracentesis needle. It goes above a rib into the space between the lining of the outside of your lungs and your chest wall, called the pleural space. You may feel pressure. Your doctor sends the collected fluid to a lab to be checked for cancer. You may be able to drive yourself home after the test.

Thoracotomy/thoracoscopy 

thoracotomy
Thoracotomy: One way for doctors to get a lung biopsy.

A thoracotomy is a type of surgery and is done in a hospital. The surgeon opens up the chest to look for lung cancer. This is usually done when the diagnosis cannot be made by any of the other methods. If possible, the surgeon removes the entire tumor during a thoracotomy.    

Here’s what to expect during a thoracotomy 

You must check into the hospital. On the day of your surgery, you get a general anesthetic. This drug puts you to sleep so that you don’t feel anything. The surgeon cuts between your ribs to expose your lungs and look for diseased tissue. The doctor takes out some of the diseased tissue and sends it to a lab to be checked for cancer. When you wake up, you’ll have a tube in your chest to drain air, fluid, and blood. You’ll need to stay in the hospital for a couple of days. During that time, you’ll get pain medication.

A similar, but slightly less invasive procedure, is a thoracoscopy. The surgeon can use this to examine and biopsy the outer surface or the linings of the lungs and other nearby structures. Like a thoracotomy, you get a general anesthetic before this procedure. But instead of making one long incision, the surgeon makes a few small cuts in the chest wall. A long, thin instrument with a small video camera on the end is inserted through one of the cuts to allow the surgeon to see, and special instruments are inserted through the other cuts to sample any abnormal areas. Because the incisions are smaller, people usually recover quicker from this type of procedure.