CT-guided Lung Biopsy
What is a CT-guided Lung Biopsy?
A lung nodule is a small area in the lung that appears different from the surrounding lung, and is usually found on X-ray or CT scan images.
When the nodule has certain features, or becomes larger over time, a biopsy may be done to help decide whether the nodule needs to be removed, or treated with medicine or radiation. A biopsy is a way of removing very small pieces of tissue, so that a pathologist can examine the tissue under a microscope and determine what kind of nodule it is. Usually, a CT-guided needle biopsy is chosen when the lung nodule cannot be reached by bronchoscopy. A needle biopsy may not be appropriate for patients with severe emphysema, blood-clotting disorders or pulmonary hypertension.
How should I prepare?
You may be instructed not to eat or drink for several hours before the procedure. You will be instructed not to take blood thinners or aspirin for a specific number of days before a biopsy. However, you may take your usual medications with sips of water. If you are diabetic and take insulin, discuss with your doctor whether to adjust your insulin dose.
Inform your doctor of all medications you are taking, and any allergies to medications or to latex. Women should always inform their physician if there is a possibility they may be pregnant. You will need to have a responsible friend or relative to accompany you and drive you home afterward.
How is the procedure performed?
The CT scan is used to find the safest path to the nodule. Scan images will be repeated to accurately place a very thin needle through the skin and between the ribs, so the tip of the needle is inside the nodule. Then, the tissue samples are removed through that needle, and finally the needle is removed. The tissue samples are sent to a laboratory to be processed and analyzed by a pathologist.
How will I get the results of this test?
The pathology results will usually be available in about three to four business days after the procedure. They will be sent to your physician.
Please contact your referring physician if you have not received these results after one week.
What will I experience during and after the procedure?
You will be asked to remove your clothing above the waist and wear a gown for the procedure. You will positioned on the CT table where the scan is done. The skin is cleansed and a local anesthetic given, which may sting briefly. Placement of the biopsy needle should then be painless. You will have to be motionless for up to 30 minutes, breathing normally. You will be asked to avoid coughing and may need to follow breathing instructions. After the needle is removed and a dressing applied, you will be monitored by our nursing staff, and a chest X-ray, done about two to three hours after the procedure, will be reviewed by the radiologist.
After the procedure, avoid strenuous exertion for 24 hours. If you are considering air travel soon after the biopsy, inform the radiologist. Signs of a collapsed lung, which can occur after a needle biopsy, include new chest or shoulder pain on the side of the biopsy, difficulty breathing, or rapid pulse rate. If you develop these symptoms, go to the nearest emergency room and inform the emergency physician of your recent lung biopsy.
What are the benefits and risks?
Needle biopsy is a reliable and accurate way to determine whether a lung nodule is benign or malignant, and to decide what course of treatment is necessary. Needle biopsy is safer and easier to tolerate than surgical biopsy, and the recovery time is brief.
There are some risks, which include coughing up a small amount of blood for a brief time after the procedure. A significant amount of bleeding is very uncommon.
Air may leak from the punctured lung and be trapped within the chest. This is called a pneumothorax. A pneumothorax occurs in up to 30 percent of lung needle biopsies, however, it is often small and asymptomatic. If a large amount of air leaks into the chest, it may cause the lung to empty or collapse, and the patient may experience chest pain or trouble breathing. A thin plastic tube would have to be placed remove the leaked air and allow the lung to re-expand. A chest tube needs to be placed in approximately five to 15 percent of cases and would likely require an overnight stay in the hospital.
In a small percentage of biopsies, the tissue obtained may not be sufficient to give a diagnosis, which would require another biopsy or surgery.
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