A lung biopsy is an interventional procedure performed to diagnose lung

pathology Pathology is the study of the causes and effects of disease or injury. The word ''pathology'' also refers to the study of disease in general, incorporating a wide range of biology research fields and medical practices. However, when used in ...

by obtaining a small piece of lung which is examined under a microscope. Beyond microscopic examination for cellular morphology and architecture, special stains and cultures can be performed on the tissue obtained.

Types

A lung biopsy can be performed

percutaneous {{More citations needed, date=January 2021 In surgery, a percutaneous procedurei.e. Granger et al., 2012 is any medical procedure or method where access to inner organs or other tissue is done via needle-puncture of the skin, rather than by using ...

ly (through the skin, typically guided by a CT Scan), via

bronchoscopy Bronchoscopy is an endoscopic technique of visualizing the inside of the airways for diagnostic and therapeutic purposes. An instrument (bronchoscope) is inserted into the airways, usually through the nose or mouth, or occasionally through a trac ...

with

ultrasound Ultrasound is sound waves with frequencies higher than the upper audible limit of human hearing. Ultrasound is not different from "normal" (audible) sound in its physical properties, except that humans cannot hear it. This limit varies ...

guidance, or by surgery, either

open Open or OPEN may refer to: Music * Open (band), Australian pop/rock band * The Open (band), English indie rock band * ''Open'' (Blues Image album), 1969 * ''Open'' (Gotthard album), 1999 * ''Open'' (Cowboy Junkies album), 2001 * ''Open'' ( ...

or by video-assisted thoracoscopic surgery (VATS).

Reasons to perform

A lung biopsy is performed when a lung

lesion A lesion is any damage or abnormal change in the tissue of an organism, usually caused by disease or trauma. ''Lesion'' is derived from the Latin "injury". Lesions may occur in plants as well as animals. Types There is no designated classif ...

is suspicious for

lung cancer Lung cancer, also known as lung carcinoma (since about 98–99% of all lung cancers are carcinomas), is a malignant lung tumor characterized by uncontrolled cell growth in tissues of the lung. Lung carcinomas derive from transformed, malign ...

, or when cancer cannot be distinguished from another disease, such as

aspergillosis Aspergillosis is a fungal infection of usually the lungs, caused by the genus ''Aspergillus'', a common mould that is breathed in frequently from the air around, but does not usually affect most people. It generally occurs in people with lung di ...

. Lung biopsy also plays a role in the diagnosis of

interstitial lung disease Interstitial lung disease (ILD), or diffuse parenchymal lung disease (DPLD), is a group of respiratory diseases affecting the interstitium (the tissue and space around the alveoli (air sacs)) of the lungs. It concerns alveolar epithelium, pu ...

Risks

Any approach to lung biopsy risks causing a

pneumothorax A pneumothorax is an abnormal collection of air in the pleural space between the lung and the chest wall. Symptoms typically include sudden onset of sharp, one-sided chest pain and shortness of breath. In a minority of cases, a one-way valve i ...

. Careful technique can limit this risk, which ranges from less than 1% to about 10%. The precise risk of pneumothorax depends on technique and on underlying lung disease, as certain lung diseases such as

COPD Chronic obstructive pulmonary disease (COPD) is a type of progressive lung disease characterized by long-term respiratory symptoms and airflow limitation. The main symptoms include shortness of breath and a cough, which may or may not produce ...

can increase the risk of pneumothorax. Pneumothorax sometimes requires treatment with a

chest tube A chest tube (also chest drain, thoracic catheter, tube thoracostomy or intercostal drain) is a surgical drain that is inserted through the chest wall and into the pleural space or the mediastinum in order to remove clinically undesired substance ...

. Bleeding can be life-threatening and can occur in 1 to 4%. Rarely, intercostal artery can be injured when biopsy needle is punctured through the back, due to variations in the course of the artery during its first 6 cm from the spine when emerged from the midline vessels such as costocervical trunk of subclavian artery and descending

thoracic aorta The descending thoracic aorta is a part of the aorta located in the thorax. It is a continuation of the aortic arch. It is located within the posterior mediastinal cavity, but frequently bulges into the left pleural cavity. The descending thoracic ...

. There is a higher chance of the artery deviated from its usual course of groove below the ribs (subcostal groove), for the ribs that are nearer to the head. Therefore, target lesions near the back of the lungs are usually avoided if possible, and the puncture should be as near to the superior margin of the ribs as possible during biopsy.

References

{{reflist Biopsy