What is Needle Biopsy of Lung (Chest) Nodules?
A nodule is defined as a relatively round lesion that is less than three centimeters in diameter. A lung nodule is located within the lung itself, not in the airways. A patient with a lung nodule usually experiences no symptoms; the nodule is most often detected on a chest x-ray. More than half of solitary or single nodules within the chest are benign, or non-cancerous, usually due to a previous infection. However, all solitary chest nodules are considered potentially malignant until proven otherwise, and for this a needle biopsy may be required. A biopsy involves removing a small piece of tissue for examination by a physician. A needle biopsy, sometimes called a needle aspiration, is the easiest way that tissue can be safely removed from the body. The procedure, which is most often performed by a radiologist or interventional radiologist, involves a needle that is inserted through the skin. The needle biopsy may use a syringe or an automated needle to obtain the tissue sample.

What are some common uses of the procedure?
Once a nodule is detected, a computed tomography (CT) or positron emission tomography (PET) scan may be performed to help characterize it and to help estimate the likelihood of malignancy. If the CT or PET scan cannot clearly identify positively benign features in the nodule, a needle biopsy may be necessary. When a physician orders a needle biopsy, the nodule is usually believed to be unreachable by other diagnostic techniques, such as bronchoscopy.

How should I prepare for the procedure?
In general, you should have nothing to eat or drink for eight hours prior to your biopsy. However, you may take your routine medications with sips of water. If you are diabetic and take insulin, you should talk to your doctor; who will probably have you adjust your usual insulin dose. Prior to a needle biopsy, you should report to your physician all medications that you are taking, including herbal supplements. It is especially important to let your physician know if you are taking medications that may cause you to bleed, such as aspirin or other blood thinners. You may need to stop using these medications for several days prior to your biopsy. You should have a friend, spouse and/or relative accompany you to the hospital and provide transportation home following the procedure.

What does the equipment look like?
A biopsy needle is generally several inches long and the barrel has a thickness similar to a large paper clip. The needle is hollow so it can capture the tissue specimen. This procedure is also called a needle aspiration, because the tissue specimen is pulled into the needle by suction. On occasion, an automated needle will be used which has a spring-loaded device that retrieves a small tissue specimen in its collecting chamber.

How does the procedure work?
Depending on the location of the nodule, needle biopsies are often performed with image guidance. CT, fluoroscopy, and sometimes, ultrasound are used for this procedure. For nodules that are small and deep within the lung, or located near blood vessels, airways or nerves, CT allows better planning of the needle path for a safe biopsy. CT-guided biopsies require patients to be able to hold still on the CT table for up to 30 minutes. Fluoroscopy and ultrasound allow real-time monitoring of the needle and are often easier for patients who have difficulty holding their breath.

How is the procedure performed?
If your procedure is performed with fluoroscopy, you will sit, with your arms facing forward for the procedure. If your procedure is performed with CT, you will lie down during the procedure. Once you are in a comfortable position, a limited CT scan will be performed to confirm the location of the nodule to be biopsied and the safest approach to the nodule. Once the location of the nodule is confirmed , the entry site is marked on the skin. The skin around the insertion site will be scrubbed and disinfected, and a clean and sterile drape will be applied. A local anesthetic will be injected to numb the path of the needle through the skin, muscle and lining of the chest cavity. Then, a small incision, approximately 1/8 of an inch, will be made into the skin, so that the biopsy needle can be inserted. You will be asked to remain still and not to cough during the procedure. In addition, you will be asked to hold your breath multiple times during the biopsy. It is critical that you try to maintain the same breath hold each time to insure proper needle placement. Using image guidance, the physician will direct the needle to the site of the nodule to remove a small specimen of tissue. Several specimens may be needed for complete analysis. After this sampling, the needle will be removed. Once bleeding has stopped at the site of the incision, a bandage will be applied. Bleeding will be minimal, and no stitches will be required. The entire procedure typically lasts an hour. After the biopsy, you will go to an observation area for several hours to check for possible complications. Chest x-ray(s) may be performed to monitor for complications.

What will I experience during the procedure?
Local anesthesia or numbing medication will be given at the skin site to minimize pain. You may feel a stinging sensation as the local anesthetic is injected. The area will become numb within a short time. You may be given a mild sedative prior to the biopsy, and in addition, sedation or relaxation medication may be given intravenously during the procedure, if needed. Your bandage may be removed one day following the procedure, and you may bathe or shower as normal. No stitches will need to be removed. You should not exert yourself physically (such as heavy lifting, extensive stair climbing, sports, etc.) or travel by airplane the night of and for one full day following your biopsy. On the second day, if you feel up to it, you may return to your normal activities. You may experience some soreness at the biopsy site as the local anesthesia fades, but this should improve. You may also cough up a little blood, but this should be minimal. These symptoms will gradually fade over the 12 to 48 hours following the procedure. Signs of a collapsed lung, which sometimes occurs following a needle biopsy of the chest, include shortness of breath, difficulty in catching your breath, rapid pulse (heart rate), sharp chest or shoulder pain with breathing, and/or blueness of the skin. If you experience any of these symptoms, go to the nearest Emergency Room, and contact your physician as soon as possible.

Who interprets the results and how do I get them?
The lung tissue specimen will be sent to a laboratory, where a pathologist will examine it. Results should be available within a few days. Your primary care physician should receive the biopsy results and discuss them with you. In a small number of cases, the tissue obtained may not be adequate for diagnosis. In that case, your doctor will discuss the next steps.

What are the benefits vs. risks?

Benefits

Risks

What are the limitations of Needle Biopsy of Lung Nodules?
In a small number of cases, the tissue obtained during a biopsy may not be adequate for diagnosis. Needle biopsy is not cost-effective for small lesions one to two millimeters in diameter. The needle is too difficult to position into the nodule and the nodule is too small to provide enough tissue for an accurate diagnosis. For patients with certain conditions associated with emphysema, lung cysts, blood coagulation disorder of any type, insufficient blood oxygenation, pulmonary hypertension, and certain heart failure conditions, a needle biopsy may not be recommended. In these situations, your physician and the physician performing the biopsy will work together to help decide the best course of treatment. Alternatives to lung biopsy usually include continued follow-up with imaging and surgical removal of the abnormality.