A lung biopsy is an interventional procedure performed to diagnose

lung The lungs are the primary organs of the respiratory system in humans and most other animals, including some snails and a small number of fish. In mammals and most other vertebrates, two lungs are located near the backbone on either side of t ...

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 percutaneously (through the skin, typically guided by a

CT Scan A computed tomography scan (CT scan; formerly called computed axial tomography scan or CAT scan) is a medical imaging technique used to obtain detailed internal images of the body. The personnel that perform CT scans are called radiographers ...

), via bronchoscopy with

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

guidance, or by

surgery Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pat ...

, either

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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 classifi ...

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 tissue (biology), tissues of the lung. Lung carcinomas derive from tran ...

, 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 dise ...

. 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, pulmo ...

Risks

Any approach to lung biopsy risks causing a pneumothorax. 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 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 substanc ...

. Bleeding can be life-threatening and can occur in 1 to 4%. Rarely,

intercostal artery The intercostal arteries are a group of arteries that supply the area between the ribs ("costae"), called the intercostal space. The highest intercostal artery (supreme intercostal artery or superior intercostal artery) is an artery in the human ...

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 The costocervical trunk arises from the upper and back part of the second part of subclavian artery, behind the scalenus anterior on the right side, and medial to that muscle on the left side. Passing backward, it splits into the deep cervica ...

subclavian artery In human anatomy, the subclavian arteries are paired major arteries of the upper thorax, below the clavicle. They receive blood from the aortic arch. The left subclavian artery supplies blood to the left arm and the right subclavian artery supplie ...

and descending thoracic aorta. 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