When Might a Lung Biopsy be Necessary?

A lung biopsy is a medical procedure performed to remove a sample of tissue from the lungs to determine the presence of lung disease or lung cancer. The procedure is done using an open or closed method. Closed biopsies are performed through the skin or trachea (windpipe) while open biopsies are done in the operating room under general anesthesia. Which method your doctor chooses will depend upon what part of the lungs the sample is taken from and your overall, general health.[1]

The Four Methods of Lung Biopsy

A lung biopsy is performed using one of the following four methods:

  1. Transbronchial biopsy: also referred to as a bronchoscopic biopsy, this type of biopsy uses a lighted, fibro-optic bronchoscope that’s inserted into the airway through the nose or mouth to remove a sample of tissue from the lungs. A transbronchial biopsy might be used if the abnormal lung tissue is near the bronchi (large air passages) or before resorting to more invasive procedures such as an open biopsy (see below).
  2. Needle biopsy: also referred to as a closed, transthoracic or percutaneous (through the skin) biopsy, a needle biopsy is done under a local anesthetic with a long needle that’s inserted through the chest wall and guided by computed tomography, ultrasound of fluoroscopy to the suspicious area. This type of biopsy might be used if the abnormal lung tissue is close to the chest wall.
  3. Thorocoscopic biopsy: also referred to as video-assisted thorocoscopic surgery (VATS), this type of biopsy uses an instrument called a thoracoscope that’s passed through a small incision (cut) in the chest wall to remove a sample of abnormal lung tissue. VATS is usually done under general anesthesia and is less invasive than an open biopsy (see below). VATS might be used as a diagnostic tool or for therapeutic purposes in minimally invasive biopsies/surgeries involving the pleura (each of a pair of membranes lining the chest cavity and lungs), lungs and mediastinum (a membranous partition between the lungs).[3]
  4. Open biopsy: this type of biopsy uses a surgical procedure to make an incision between the ribs to remove a sample of abnormal lung tissue below. An open biopsy might be performed when other lung biopsy methods have failed, are contraindicated (should not be used) or when a larger piece of lung tissue is needed to make a particular diagnosis.

Lung Biopsy Risks

In general, lung biopsies are safe procedures with bronchoscopic and needle biopsies being safer than thoracoscopic and open biopsies. It’s important to understand your risks will be higher if you have a severe lung disease. Before the procedure, your doctor should discuss the possible risks with you which may include:

  • Collapsed lung – may occur during a lung biopsy which then requires placement of a chest tube to re-inflate your lungs until the biopsy site heals.
  • Severe bleeding – also called hemorrhage, may occur in the lungs during or after the procedure.
  • Infection – it’s possible that an infection like pneumonia may occur, but it can usually be treated with antibiotics.
  • Bronchial spasms – inserting instruments into the air passages to remove lung tissue samples can cause sudden, involuntary constriction of the bronchial tubes which may impact your breathing, especially immediately following the procedure.
  • Irregular heart rhythms – extremely rare but may occur.
  • Death – in rare cases death may occur, especially if you have severe lung disease and/or you develop complications related to general anesthesia.

After the Lung Biopsy

After your procedure is over, you should call the doctor immediately if you develop:

  • Fever
  • Severe chest pain
  • Lightheadedness or dizziness
  • Shortness of breath or difficulty breathing
  • Excessive bleeding that’s leaked through the bandage
  • Coughing up of more than a tablespoon of blood

For more information about having a lung biopsy, talk to your primary care provider or your pulmonologist.

[1]Johns Hopkins Medicine. Lung Biopsy. Accessed January 23, 2018.

[2]WebMD. Lung Biopsy. Last reviewed August 21, 2015.

[3] Medscape. Video-Assisted Thoracoscopic Surgery (VATS). Accessed January 23, 2018.