Lung Biopsy

Surgeons utilize biopsies to remove a solid or fluid tissue sample for cellular analysis. A biopsy helps physicians narrow down an accurate diagnosis, which can inform your available treatment options. The most common type of biopsy is the VATS procedure, and recovery time is about two weeks.

What Is a Lung Biopsy and Why Am I Having It?

A lung biopsy is the removal of a small piece of lung tissue. Doctors often order a lung biopsy to obtain lung tissue for analysis. A biopsy is necessary to determine the specific type of lung cancer a person has and the most appropriate course of treatment.

The excision of lung tissue is also called a wedge resection and is ideal for smaller lesions that are not deep in the lung tissue. You may have heard the term lung nodules, masses or spots, which all refer to abnormal lesions in the lung that appear on radiological exams such as MRI or CT scans.

Doctors recommend a lung biopsy or wedge resection for patients with unidentified masses that require removal. Patients who require the removal of a more significant amount of lung tissue may need to undergo a more extensive resection, called a lobectomy.

What Should I Do Before the Lung Biopsy Procedure?

There are several things you must do prior to the procedure, including:

• Stop taking blood thinners at least five days before your procedure.
• Do not eat or drink anything after midnight the night before surgery.
• You may continue taking anti-inflammatories up until your surgery.
• Take morning medications with a sip of water the day of surgery.
• If you are taking medication for diabetes, take half of your normal dose.

Consider adding light exercise, such as walking or stretching, to your daily routine. Your diet should also consist of proper nutrition, which can improve healing time. Daily walks, a healthy diet and a positive attitude, along with support from friends and family, will increase your chances of a prompt and successful recovery.

It is advisable, but not mandatory, for patients who smoke or use tobacco to quit at least two weeks before their surgery. During the first two weeks after stopping tobacco use, your airways produce more secretions, or phlegm, making your recovery more difficult. Your family physician will have information on smoking cessation strategies and support groups.

What Should I Expect the Day of My Lung Biopsy?

On the day of your procedure, the staff at Moffitt Cancer Center will guide you through the admitting process leading up to your surgery time. During surgery, you will be completely asleep from general anesthesia. Patients do not feel anything while undergoing the procedure.

Admitting Procedures

Plan to arrive at Moffit Cancer Center about two hours before the time of your scheduled surgery. Your surgeon’s team will provide the exact time. Feel free to use the complimentary valet parking service. Check in at the Surgical Admissions desk and they will provide you with further assistance. Family and friends may stay with you until the time of your surgery.

What Happens in the Operating Room?

Once you enter the operating room, anyone accompanying you must wait in the Surgical Waiting Area until your surgeon comes out to speak with them. Delays or changes in the operating room schedule are not infrequent and should not alarm or worry them.

• General Anesthesia: You will receive general anesthesia and be completely asleep during the entire procedure. The surgical team administers anesthesia through an intravenous line and ensures you do not experience anything during the surgery.
• VATS Procedure: The surgeon uses a thoracoscopy process known as VATS (video-assisted thoracic surgery) for the biopsy. This minimally invasive technique uses small incisions through which the surgeon inserts a small camera and long, thin instruments.
• Bronchoscopy: The surgeon performs a bronchoscopy with a camera to examine your trachea, also known as your windpipe.
• Surgical Incision: After bronchoscopy, the surgeon makes a small half-inch cut between your ribs, which allows the passage of a small camera into the chest. The surgeon inspects the inside of the chest and makes one to three additional incisions to locate the growth or biopsy area.
• “Wedge” Removal: The operating physician then uses surgical staplers to remove a small piece or “wedge” of the lung containing the nodule or abnormality. After removing the mass, the staplers create a tight seal over the remaining lung tissue.
• Insertion of Drainage Tube: The surgeon inserts a flexible plastic tube about the length of your pinky finger into the chest to drain any fluid or air after surgery.
• Final Inspection and Sutures: Lastly, the surgeon inspects the lung one final time to make sure it expands properly, then closes the skin using dissolvable stitches and a liquid-plastic dressing.

Mediastinoscopy Procedure

In some cases, your doctor may want to examine the mediastinum. A mediastinoscopy allows your doctor to see the space between your lungs in the middle of the chest. First, your surgeon makes a small one-inch cut on the lower neck just above the clavicles. The surgeon then inserts a unique scope into the chest to take biopsies of the lymph nodes.

A modified form of this surgery, called a Chamberlain procedure, allows your physician to obtain biopsies from additional lymph nodes. This method involves another small, one-inch cut on the left side of your chest, and the surgery takes about 45 minutes.

Endobronchial Ultrasound

If you are undergoing endobronchial ultrasound bronchoscopy, your surgeon will take lymph node biopsies through the trachea. This method is less invasive than a mediastinoscopy, and no incisions are needed.

EBUS provides real-time imaging of the airways’ surface, blood vessels, lungs and lymph nodes. These images allow the physician to view difficult-to-reach areas and access more lymph nodes for biopsy with needle aspiration.

What Should I Expect After the Lung Biopsy?

After the procedure, you will wake up in the recovery room and may feel sleepy for a short time. Plan to spend the first one or two nights in the hospital. Most people experience a temporary sore throat from the breathing tube used during surgery. Swallowing may hurt slightly for one to two days or longer for patients who underwent a mediastinoscopy or Chamberlain procedure.

Preventing Pneumonia and Blood Clots

Once you go home, it is vital to walk and perform breathing exercises to prevent pneumonia and blood clots. It is essential to begin walking and breathing exercises within a few hours after your surgery, as the consequences of not doing so are potentially life-threatening.

A specialized team of nurses, respiratory and physical therapists will help you with these

breathing exercises using something called an incentive spirometer. You are usually out of bed and in a chair on the same day as surgery and walking the next morning.

Pain Management

The nursing staff will control your pain with medications through a small IV in your arm or hand. Before you go home, a doctor will prescribe pain medication for you to take at home.

After surgery, you will be able to eat regular foods but may have some nausea from the anesthesia. Some patients find it easier to eat in small amounts for the first few days. You can also request anti-nausea medications from your doctor.

Chest Tube Removal

Your doctor will remove your chest tube once your lung tissue has healed and is no longer leaking air. Removal usually occurs within the first two days after surgery. Before you go home you will have a small stitch placed to close the skin, which your doctor will take out at the next follow-up. You may remove the dressing over your suture and shower the next day.

In rare cases, the lung tissue may take longer to heal and air may continue to leak out of the tube. In these cases, the chest tube must remain in place a little longer as the lung tissue heals, which may take another few days or up to two weeks. Once the leak has healed, the surgeon will remove the chest tube in the office.

What Should I Expect After Leaving the Hospital?

Knowing what to expect following your release from the hospital will help you and your family prepare for home care. There are several factors to consider, including the following:

• Pain Management: You will have a prescription for Vicodin or Percocet for pain control, but it is also useful to take an anti-inflammatory such as Motrin or Advil. If you feel nauseous, you may need to reduce the Vicodin or Percocet. You may also need to take laxatives or stool softeners, as constipation is a side effect of pain medications.
• Preventative Exercise: Once you are home, it is essential to continue walking at least three times per day to prevent blood clots caused by inactivity. You should also continue to use the incentive spirometer for breathing exercises. These exercises help restore respiratory function and prevent complications from blood clots.
• Dressing Removal: If you are discharged home with a dressing, you may remove it the next day. You should shower daily but avoid tub baths or swimming until following up with your surgeon.
• Diet and Medication: You may resume your regular diet once you are home. If you are on blood thinners such as Coumadin (warfarin) or Plavix (clopidogrel) you may continue these as instructed by your surgeon’s team.

After Lung Biopsy Care

Some pain is expected in the days following your surgery and can worsen with activity. You can continue taking pain medication as necessary and wean yourself off it as tolerated. Pain medication such as Vicodin or Percocet can cause nausea, which may require you to reduce the amount you take.

Pain medication can also lead to constipation, which can be relieved with over-the-counter stool softeners. You may cough up phlegm with small amounts of blood for the first few days, but this should resolve within the first week.

Contact your surgeon’s team if you have any of the following:

• Temperature over 101F or 38C
• Significant redness at the surgical site
• Thick discharge from your wounds
• Worsening shortness of breath
• Increased swelling or puffiness around your wounds, breast or neck

Potential Complications

The potential risk of complications with a lung biopsy is relatively low. The most common complication is pneumothorax, which is the presence of air in the chest cavity. Air that becomes trapped between the lungs and chest wall can cause partial or total lung collapse, leading to shortness of breath or chest pain.

A small pneumothorax will typically self-resolve or is easily treatable with oxygen, and often has no long-term effects. Other complications of lung biopsies include:

• Air Embolism: Systemic air embolism is rare but can be deadly if air enters the heart or brain through the arterial bloodstream. Surgeons take many precautions to minimize this risk, and most embolisms are treatable through oxygen administration.
• Seeding of the Tract: In some rare cases, cancer tissue removed during a biopsy can lead to metastasis, or the spread of cancer cells in the lung or chest wall, as the needle travels through these structures. Depending on the tumor cell type, lung cancer treatment may include radiation therapy or surgical resection.
• Vascular Complications: The presence of blood when coughing is a sign of mild vascular damage and often self-resolves. In more severe and extremely uncommon cases, surgeons will stop the bleeding in the chest wall and drain excess fluid with a small-bore chest tube placed during interventional radiology.

When Can I Resume Normal Activities?

Returning to your usual activities must be done slowly and with particular attention to how you feel and what your pain levels are. While there are no strict guidelines for resuming activities, pay attention to your body and be careful not to over-exert yourself.

Post-Surgery

You should not lift anything over 10 pounds for the first two weeks after surgery, but you can engage in light housework with frequent breaks. Immediately after surgery you should begin the recommended exercises, including walks around the house, around the block or up a flight of stairs.

With each activity you resume, go slowly and carefully at first. Always slow down if you have pain, shortness of breath or are exhausted afterward.

After Two Weeks

After one to two weeks you may slowly resume activities such as driving, office work,

gardening, grocery shopping, walking the dog, going out to dinner or a movie and sexual activity. You may resume air travel by plane within two weeks after surgery.

When Do I Get My Lung Biopsy Results?

In many cases, your doctor will provide your results within two to three days after the biopsy. Biopsy results that require a more detailed analysis can take up to two weeks. Ask your surgical team how you will receive the biopsy results and when to expect them. You should also ask for information on who to contact for an explanation of the final report.

When Do I Return for Follow-Up?

You will follow up with your surgeon within seven to 10 days after discharge. During this visit, the nursing staff will remove your chest tube stitch and the surgical team will discuss the next steps in your care. Your surgeon will likely obtain a chest X-ray during this visit. It is also an appropriate time to ask any questions about activity restrictions or returning to work.

Sources:

Solaini, L. et al. (2008). Video-assisted thoracic surgery (VATS) of the lung. Retrieved from https://link.springer.com/article/10.1007/s00464-007-9586-0

Lorenz, J. & Blum, M. (2006). Complications of Percutaneous Chest Biopsy. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3036363/

Ooi, A. et al. (2005, June). VATS Lung Biopsy in Suspected, Diffuse Interstitial Lung Disease Provides Diagnosis, and Alters Management Strategies. Retrieved from https://www.sciencedirect.com/science/article/abs/pii/S1443950605000260