A needle biopsy is a procedure in which a sample of tissue is removed from the lungs to examine it for cancerous (malignant) cells. The biopsy may use a fine needle or a core needle. The fine needle is very thin – thinner than the needles used for blood tests – and removes a small amount of tissue from the suspicious area. This is also referred to as fine needle aspiration. A core needle biopsy uses a slightly larger needle to extract larger pieces (cores) of tissue. Both types of needle biopsy are often guided using imaging, such as chest x-ray, CT (computed tomography) scan, ultrasound, or MRI (magnetic resonance imaging).1-3
When are needle biopsies performed?
Needle biopsies are frequently performed when a suspicious lung nodule has been found on chest x-ray or CT scan. Lung nodules, also called pulmonary nodules, are small round or oval shaped growths. They are smaller than 3 centimeters. Growths larger than 3 centimeters are called a mass, and these are more likely to be malignant. Nodules may be malignant or benign (not cancerous). In fact, over 90% of lung nodules that are smaller than 2 centimeters are benign and can be caused by infections, inflammation or a non-cancerous abnormal growth. Larger and more irregularly shaped nodules are more likely to be malignant.4
Needle biopsies are often performed on an outpatient basis, meaning the patient does not need to stay in the hospital overnight. Patients may be given a mild sedative through an IV (intravenous) line to aid in relaxation and alleviate anxiety about the procedure. Local anesthetic is used to numb the path of the needle. Depending on the imaging techniques used, the patient may be upright or lying down. Patients are asked to remain still and not cough during the procedure.3
Removing samples of tissue
Using guidance from the imaging, the doctor will insert the needle through the skin to the location of the nodule to remove samples of tissue. Once the biopsy is completed, a bandage will be placed on the skin. The tissue samples are then sent to the laboratory to be examined by a pathologist, a physician who specializes in the diagnosis of diseases based on analyzing bodily fluids or tissues.3
Patients are instructed not to physically exert themselves after a needle biopsy. Heavy lifting, playing sports, or engaging in strenuous exercise should be avoided. Patients should discuss additional aftercare instructions with their physician.3
Safety and side effects
Patients commonly experience some soreness at the biopsy site. Some patients also cough up a little blood following the procedure. These symptoms should fade over 12-48 hours after the biopsy. Sometimes, patients can experience a collapsed lung (pneumothorax) after this procedure. Symptoms of a collapsed lung can include blueness of the skin, chest pain, rapid heart rate, and shortness of breath. Patients experiencing any of these symptoms should seek immediate medical attention.1,3
In a recent study that evaluated the safety of needle biopsies, researchers found that partial lung collapse occurred in 15% of the more than 15,000 patients who underwent a lung biopsy in the trial. In about 7% of patients, the lung collapse was serious and required the placement of a chest tube and a brief hospital stay. Those patients were also more likely to develop respiratory failure, requiring the use of a breathing machine. Only 1% of patients experienced bleeding, and about 1 in 5 of those patients experiencing bleeding required a blood transfusion. Patients who were smokers, who were aged 60 to 69 years of age, and those who had chronic obstructive pulmonary disease (COPD) were more likely to experience these complications.2
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