| Needle Biopsy of Lung (Chest) 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 |
