LUNG BIOPSY
Category: Thoracic Surgery
Abstract : Lung biopsy Definition Lung biopsy is a procedure for obtaining a small sample of lung tissue for examination. The tissue is usually examined under a microscope, and may be sent to a microbiological laboratory for culture. Microscopic examination is performed by a pathologist. Purpose A lung biopsy is usually performed to determine the cause of abnormalities, such as nodules th
Lung biopsy
Definition
Lung biopsy is a procedure for obtaining a small sample of lung tissue for examination. The tissue is usually examined under a microscope, and may be sent to a microbiological laboratory for culture. Microscopic examination is performed by a pathologist.
Purpose
A lung biopsy is usually performed to determine the cause of abnormalities, such as nodules that appear on chest x rays.
It can confirm a diagnosis of cancer, especially if malignant cells are detected in the patient’s sputum or bronchial washing. In addition to evaluating lung tumors and their associated symptoms, lung biopsies may be used to diagnose lung infections, especially tuberculosis and Pneumocystis pneumonia, drug reactions, and chronic diseases of the lungs such as sarcoidosis and pulmonary fibrosis.
A lung biopsy can be used for treatment as well as diagnosis. Bronchoscopy, a type of lung biopsy performed with a long, flexible slender instrument called a bronchoscope, can be used to clear a patient’s air passages of secretions and to remove airway blockages.
Demographics
According to the American Cancer Society, approximately 77% of all cancers are diagnosed in people ages 55 and older. Lung cancer is the leading cause of cancer deaths in the United States. Each year, about 170,000 Americans are diagnosed with lung cancer. It is much more prevalent among African Americans than the general population. Nine out of 10 cases of lung cancer are caused by smoking cigarettes, pipes, or cigars.
Description
Overview
The right and left lungs are separated by the mediastinum, which contains the heart, trachea, lymph nodes, and esophagus. Lung biopsies sometimes involve mediastinoscopy.
Types of lung biopsies
Lung biopsies are performed using a variety of techniques, depending on where the abnormal tissue is located in the lung, the health and age of the patient, and the presence of lung disease. A bronchoscopy is ordered if a lesion identified on the x ray seems to be located on the wall (periphery) of the chest. If the suspicious area lies close to the chest wall, a needle biopsy can be done. If both methods fail to diagnose the problem, an open lung biopsy may be performed. When there is a question about whether the lung cancer or suspicious mass has spread to the lymph nodes in the mediastinum, a mediastinoscopy is performed.
BRONCHOSCOPIC BIOPSY.
During the bronchoscopy, a thin, lighted tube (bronchoscope) is passed from the nose or mouth, down the windpipe (trachea) to the air passages (bronchi) leading to the lungs. Through the bronchoscope, the physician views the airways, and is able to clear mucus from blocked airways, and collect cells or tissue samples for laboratory analysis.
NEEDLE BIOPSY.
The patient is mildly sedated, but awake during the needle biopsy procedure. He or she sits in a chair with arms folded in front on a table. An x ray technician uses a computerized axial tomography (CAT) scanner or a fluoroscope to identify the precise location of the suspicious areas. Markers are placed on the overlying skin to identify the biopsy site. The skin is thoroughly cleansed with an antiseptic solution, and a local anesthetic is injected to numb the area. The patient will feel a brief stinging sensation when the anesthetic is injected. The physician makes a small incision, about half an inch (1.25 cm) in length.
The patient is asked to take a deep breath and hold it while the physician inserts the biopsy needle through the incision into the lung tissue to be biopsied. The patient may feel pressure, and a brief sharp pain when the needle touches the lung tissue. Most patients do not experience severe pain. The patient should refrain from coughing during the procedure. The needle is withdrawn when enough tissue has been obtained. Pressure is applied at the biopsy site and a sterile bandage is placed over the incision. A chest x ray is performed immediately after the procedure to check for potential complications. The entire procedure takes 30 to 60 minutes.
OPEN BIOPSY.
Open biopsies are performed in a hospital operating room under general anesthesia. Once the anesthesia has taken effect, the surgeon makes an incision over the lung area, a procedure called a thoracotomy. Some lung tissue is removed and the incision is closed with sutures. Chest tubes are placed with one end inside the lung and the other end protruding through the closed incision. Chest tubes are used to drain fluid and blood, and re-expand the lungs. They are usually removed the day after the procedure. The entire procedure normally takes about an hour. A chest x ray is performed immediately after the procedure to check for potential complications.
VIDEO-ASSISTED THORACOSCOPIC SURGERY.
A minimally invasive technique, video-assisted thoracoscopic surgery (VATS) can be used to biopsy lung and mediastinal lesions. VATS may be performed on selected patients in place of open lung biopsy. While the patient is under general anesthetia, the surgeon makes several small incisions in the his or her chest wall. A thorascope, a thin, hollow, lighted tube with a tiny video camera mounted on it, is inserted through one of the small incisions. The other incisions allow the surgeon to insert special instruments to retrieve tissue for biopsy.
MEDIASTINOSCOPY.
This procedure is performed under general anesthesia. A 2–3 in (5–8 cm) incision is made at the base of the neck. A thin, hollow, lighted tube, called a mediastinoscope, is inserted through the incision into the space between the right and the left lungs. The surgeon removes any lymph nodes or tissues that look abnormal. The mediastinoscope is then removed, and the incision is sutured and bandaged. A mediastinoscopy takes about an hour.
Diagnosis / Preparation
Diagnosis
Before scheduling a lung biopsy, the physician performs a careful evaluation of the patient’s medical history and symptoms, and performs a physical examination. Chest x rays and sputum cytology (examination of cells obtained from a deep-cough mucus sample) are other diagnostic tests that may be performed. An electrocardiogram (EKG) and laboratory tests may be performed before the procedure to check for blood clotting problems, anemia, and blood type, should a transfusion become necessary.
Preparation
During a preoperative appointment, usually scheduled within one to two weeks before the procedure, the patient receives information about what to expect during the procedure and the recovery period. During this appointment or just before the procedure, the patient usually meets with the physician (or physicians) performing the procedure (the pulmonologist, interventional radiologist, or thoracic surgeon).
A chest x ray or CAT scan of the chest is used to identify the area to be biopsied. About an hour before the biopsy procedure, the patient receives a sedative. Medication may also be given to dry up airway secretions. General anesthesia is not used for this procedure.
For at least 12 hours before the open biopsy, VATS, or mediastinoscopy procedures, the patient should not eat or drink anything. Prior to these procedures, an intravenous line is placed in a vein in the patient’s arm to deliver medications or fluids as necessary. A hollow tube, called an endotracheal tube, is passed through the patient’s mouth into the airway leading to the lungs. Its purpose is to deliver the general anesthetic. The chest area is cleansed with an antiseptic solution. In the mediastinoscopy procedure, the neck is also cleansed to prepare for the incision.
Smoking cessation
Patients who will undergo surgical diagnostic and treatment procedures should be encouraged to stop smoking and stop using tobacco products. The patient needs to make the commitment to be a nonsmoker after the procedure. Patients able to stop smoking several weeks before surgical procedures have fewer postoperative complications. Smoking cessation programs are available in many communities. The patient should ask a health care provider for more information if he or she needs help with smoking cessation.
Informed consent
Informed consent is an educational process between health care providers and patients. Before any procedure is performed, the patient is asked to sign a consent form. Prior to signing the form, the patient should understand the nature and purpose of the diagnostic procedure or treatment, its risks and benefits, and alternatives, including the option of not proceeding with the test or treatment. During the discussions, the health care providers are available to answer the patient’s questions about the consent form or procedure.
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