Biopsies

Biopsies are tests in which small amounts of tissue are removed for examination to find out if a person has lung cancer and, if so, which type of lung cancer.

There are many different ways doctors can obtain tissue. Depending on which method is used, the doctor can also determine whether the cancer has spread to lymph nodes or other organs. The tissue that is removed is sent to a pathologist, who examines it and then issues a pathology report with his or her findings.

Having enough tissue available for biomarker (aka mutation, genetic, or molecular) testing can also be an important consideration. Before a biopsy is done, the patient should speak with his or her oncologist about having the tumor sample profiled. Read more about biomarker testing in the Targeted Therapy section.

Bronchoscopy

Bronchoscopy illustrationDuring a bronchoscopy, a surgeon or pulmonologist inserts a bronchoscope (a thin, flexible tube) into the patient’s mouth or nose, down the trachea, and into the lungs. A light and a camera at the end of the tube allow the doctor to look for abnormal areas. Tiny tools can be passed down through the bronchoscope to take samples of tissue, which are checked under a microscope for signs of cancer.

Prior to a bronchoscopy, a numbing medicine is sprayed in the mouth and throat. Sometimes a patient may also be given sedation through an intravenous (IV) line to prevent pain or to help the patient relax.1,2

Transthoracic needle biopsy

If a suspicious mass is in the periphery of the lungs, a needle can be passed though the chest wall with CT or ultrasound guidance to biopsy tissue or remove suspicious fluid. When a small needle is inserted through the skin of the chest wall, it is called a fine needle aspiration (FNA). If a larger sample is needed, a core biopsy is done with a larger needle.

For a transthoracic needle biopsy, the patient’s skin is numbed and an interventional radiologist inserts a needle through the chest wall. A chest CT scan or a special X-ray machine called a fluoroscope is used to help the doctor guide the needle toward the suspicious area. A sample of the mass is then aspirated, or sucked out, and sent to the lab to check for cancer cells.

An advantage of this type of biopsy is that it does not require a surgical incision, and usually local numbing medicine is all a patient needs. Disadvantages of a transthoracic needle biopsy are that sometimes it can miss small nodules or might not provide enough of a sample to make a diagnosis and perform biomarker) testing. Note: A core biopsy is usually preferred for molecular testing.

There is also a risk that air may leak out of the lung at the biopsy site and into the space between the lung and the chest wall. This complication, called a pneumothorax, can lead to trouble breathing and may cause part of the lung to collapse.1,3 A chest tube can be inserted to treat the pneumothorax, or the air may be sucked out of the space with a needle.

Thoracentesis

If a patient has a pleural effusion, doctors can perform a thoracentesis to see if it was caused by cancer that spread to the linings of the lungs. In this procedure, a doctor numbs the skin and then inserts a hollow needle between the ribs to drain the fluid. The fluid is sent to a laboratory to be checked for cancer cells.1,4

Thoracoscopy/VATS

A thoracoscopy is a surgical procedure performed in the operating room under general anesthesia. A surgeon makes a small incision in the skin of the chest wall and inserts a special instrument with a small video camera on the end to examine the lungs and inside of the chest. Samples of tissue are removed for a pathologist to look at under the microscope. This procedure is also referred to as VATS (video-assisted thoracoscopic surgery).

A thoracoscopy can be used for multiple reasons:

  • To sample tumors and lymph nodes on the outer parts of the lungs
  • To see if lung cancer has spread to the spaces between the lungs and the chest wall
  • To check if the tumor has spread to nearby lymph nodes and organs
  • As part of the treatment to remove part of a lung in some early-stage lung cancers

Because it is more invasive and requires general anesthesia, a thoracoscopy is not usually the first procedure done to get tissue to diagnose lung cancer if a less invasive procedure can be done. It is sometimes used for diagnosis if tests such as transthoracic needle biopsies are unsuccessful in getting enough tissue for the diagnosis. However, a thoracoscopy is performed more often during the treatment of lung cancer.1,5

Mediastinoscopy

This procedure is performed to get biopsies from the mediastinum. A surgeon makes a small incision in the front of the neck at the top of the breastbone. Then a thin, hollow tube with a light and a lens for viewing is inserted through the incision, along the front edge of the windpipe. Instruments are passed through the tube to take samples from the lymph nodes along the trachea. The samples are sent to a laboratory to check for cancer cells. A mediastinoscopy requires general anesthesia and is performed in an operating room, but typically as an outpatient procedure.1,6

Updated March 1, 2016


References

  1. Lung Cancer – Non-Small Cell: Diagnosis. American Society of Clinical Oncology website. http://www.cancer.net/cancer-types/lung-cancer-non-small-cell/diagnosis. Approved August 2015. Accessed February 26, 2016.
  2. What is Bronchoscopy? NIH National Heart, Lung, and Blood Institute website. http://www.nhlbi.nih.gov/health/health-topics/topics/bron. Updated February 8, 2012. Accessed February 26, 2016.
  3. Lung needle biopsy. NIH U.S. National Library of Medicine website. http://www.nlm.nih.gov/medlineplus/ency/article/003860.htm. Updated August 25, 2014. Accessed February 26, 2016.
  4. What is Thoracentesis? NIH National Heart, Lung, and Blood Institute website. http://www.nhlbi.nih.gov/health/health-topics/topics/thor. Updated February 24, 2012. Accessed February 26, 2016.
  5. Detterbeck F, Antonicelli A, Okada M. Chapter 27: Results of Video-Assisted Techniques for Resection of Lung Cancer. In: Pass HI, Ball D, Scagliotti GV, eds. The IASLC Multidisciplinary Approach to Thoracic Oncology. Aurora, CO: IASLC Press; 2014: 385-393.
  6. Mediastinoscopy with biopsy. NIH U.S. National Library of Medicine website. https://www.nlm.nih.gov/medlineplus/ency/article/003864.htm. Updated June 2, 2014. Accessed March 1, 2016.

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