| Needle Biopsy of Lung (Chest) Nodules
What is Needle Biopsy of Lung (Chest) Nodules? Back to Top
What
are some common uses of the procedure? How should I prepare for the
procedure? What does the equipment look like? How does the procedure
work? How is the procedure performed? What will I experience during the
procedure? Who interprets the results and how do I get them? What are
the benefits vs. risks? What are the limitations of Needle Biopsy of
Lung Nodules?
What is Needle Biopsy of Lung (Chest) Nodules? Back to Top
A
nodule is defined as a relatively round lesion that is less than three
centimeters in diameter. A lung nodule is located within the lung
itself, not in the airways. A patient with a lung nodule usually
experiences no symptoms; the nodule is most often detected on a chest
x-ray. More than half of solitary or single nodules within the chest
are benign, or non-cancerous, usually due to a previous infection.
However, all solitary chest nodules are considered potentially
malignant until proven otherwise, and for this a needle biopsy may be
required.
A biopsy involves removing a small piece of tissue
for examination by a physician. A needle biopsy, sometimes called a
needle aspiration, is the easiest way that tissue can be safely removed
from the body. The procedure, which is most often performed by a
radiologist or interventional radiologist, involves a needle that is
inserted through the skin. The needle biopsy may use a syringe or an
automated needle to obtain the tissue sample.
What are some common uses of the procedure? Back to Top
Once
a nodule is detected, a computed tomography (CT) or positron emission
tomography (PET) scan may be performed to help characterize it and to
help estimate the likelihood of malignancy. If the CT or PET scan
cannot clearly identify positively benign features in the nodule, a
needle biopsy may be necessary. When a physician orders a needle
biopsy, the nodule is usually believed to be unreachable by other
diagnostic techniques, such as bronchoscopy.
How should I prepare for the procedure? Back to Top
In
general, you should have nothing to eat or drink for eight hours prior
to your biopsy. However, you may take your routine medications with
sips of water. If you are diabetic and take insulin, you should talk to
your doctor; who will probably have you adjust your usual insulin dose.
Prior to a needle biopsy, you should report to your physician
all medications that you are taking, including herbal supplements. It
is especially important to let your physician know if you are taking
medications that may cause you to bleed, such as aspirin or other blood
thinners. You may need to stop using these medications for several days
prior to your biopsy.
You should have a friend, spouse and/or
relative accompany you to the hospital and provide transportation home
following the procedure.
What does the equipment look like? Back to Top
A
biopsy needle is generally several inches long and the barrel has a
thickness similar to a large paper clip. The needle is hollow so it can
capture the tissue specimen. This procedure is also called a needle
aspiration, because the tissue specimen is pulled into the needle by
suction. On occasion, an automated needle will be used which has a
spring-loaded device that retrieves a small tissue specimen in its
collecting chamber.
How does the procedure work? Back to Top
Depending
on the location of the nodule, needle biopsies are often performed with
image guidance. CT, fluoroscopy, and sometimes, ultrasound are used for
this procedure. For nodules that are small and deep within the lung, or
located near blood vessels, airways or nerves, CT allows better
planning of the needle path for a safe biopsy. CT-guided biopsies
require patients to be able to hold still on the CT table for up to 30
minutes. Fluoroscopy and ultrasound allow real-time monitoring of the
needle and are often easier for patients who have difficulty holding
their breath.
How is the procedure performed? Back to Top
If your procedure is performed with fluoroscopy, you will sit, with your arms facing forward for the procedure.
If
your procedure is performed with CT, you will lie down during the
procedure. Once you are in a comfortable position, a limited CT scan
will be performed to confirm the location of the nodule to be biopsied
and the safest approach to the nodule.
Once the location of
the nodule is confirmed , the entry site is marked on the skin. The
skin around the insertion site will be scrubbed and disinfected, and a
clean and sterile drape will be applied. A local anesthetic will be
injected to numb the path of the needle through the skin, muscle and
lining of the chest cavity. Then, a small incision, approximately 1/8
of an inch, will be made into the skin, so that the biopsy needle can
be inserted.
You will be asked to remain still and not to
cough during the procedure. In addition, you will be asked to hold your
breath multiple times during the biopsy. It is critical that you try to
maintain the same breath hold each time to insure proper needle
placement.
Using image guidance, the physician will direct the
needle to the site of the nodule to remove a small specimen of tissue.
Several specimens may be needed for complete analysis. After this
sampling, the needle will be removed. Once bleeding has stopped at the
site of the incision, a bandage will be applied. Bleeding will be
minimal, and no stitches will be required. The entire procedure
typically lasts an hour.
After the biopsy, you will go to an
observation area for several hours to check for possible complications.
Chest x-ray(s) may be performed to monitor for complications.
What will I experience during the procedure? Back to Top
Local
anesthesia or numbing medication will be given at the skin site to
minimize pain. You may feel a stinging sensation as the local
anesthetic is injected. The area will become numb within a short time.
You may be given a mild sedative prior to the biopsy, and in addition,
sedation or relaxation medication may be given intravenously during the
procedure, if needed.
Your bandage may be removed one day
following the procedure, and you may bathe or shower as normal. No
stitches will need to be removed.
You should not exert
yourself physically (such as heavy lifting, extensive stair climbing,
sports, etc.) or travel by airplane the night of and for one full day
following your biopsy. On the second day, if you feel up to it, you may
return to your normal activities.
You may experience some
soreness at the biopsy site as the local anesthesia fades, but this
should improve. You may also cough up a little blood, but this should
be minimal. These symptoms will gradually fade over the 12 to 48 hours
following the procedure.
Signs of a collapsed lung, which
sometimes occurs following a needle biopsy of the chest, include
shortness of breath, difficulty in catching your breath, rapid pulse
(heart rate), sharp chest or shoulder pain with breathing, and/or
blueness of the skin. If you experience any of these symptoms, go to
the nearest Emergency Room, and contact your physician as soon as
possible.
Who interprets the results and how do I get them? Back to Top
The
lung tissue specimen will be sent to a laboratory, where a pathologist
will examine it. Results should be available within a few days. Your
primary care physician should receive the biopsy results and discuss
them with you. In a small number of cases, the tissue obtained may not
be adequate for diagnosis. In that case, your doctor will discuss the
next steps.
What are the benefits vs. risks? Back to Top
Benefits
- Needle biopsy of a lung nodule is a reliable method of
obtaining tissue samples that can help diagnose whether a nodule is
benign or malignant.
- A needle biopsy is less
invasive than open and closed surgical biopsies, both of which involve
a larger incision in the skin and local or general anesthesia.
Risks
Whenever the skin is penetrated, the possible and common risks include, but are not limited to:
- Bleeding
- Coughing up blood (hemoptysis)
- Infection
- A
punctured lung which allows air to leak into the chest cavity, causing
the lung to collapse (pneumothorax). If a collapsed lung should occur
and is considered harmful, a small tube may be inserted into the chest
cavity to drain away the air.
What are the limitations of Needle Biopsy of Lung Nodules? Back to Top
In a small number of cases, the tissue obtained during a biopsy may not be adequate for diagnosis.
Needle
biopsy is not cost-effective for small lesions one to two millimeters
in diameter. The needle is too difficult to position into the nodule
and the nodule is too small to provide enough tissue for an accurate
diagnosis.
For patients with certain conditions associated
with emphysema, lung cysts, blood coagulation disorder of any type,
insufficient blood oxygenation, pulmonary hypertension, and certain
heart failure conditions, a needle biopsy may not be recommended. In
these situations, your physician and the physician performing the
biopsy will work together to help decide the best course of treatment.
Alternatives to lung biopsy usually include continued follow-up with imaging and surgical removal of the abnormality. Back to Top |
