Lung Biopsy

A lung biopsy is suggested by your doctor if an abnormal tissue growth or an unusual lung condition is suspected. The process involves taking a small sample of the lung tissue and studying it under the microscope to identify the actual problem. There are 4 different ways of taking a small piece of the lung tissue depending on the location from where the sample is taken and the overall condition of a person’s health.

Initially, your doctor may order an X-ray to locate or identify any abnormalities in the lungs; however, there are limitations to this kind of procedure, so a lung biopsy may be required. The reasons for this could be:

  • A mass or nodule is suspected in the lungs or area surrounding the lungs.
  • A lung infection is suspected, which could either be viral, fungal or bacterial e.g. tuberculosis.
  • To diagnose a lung disease (e.g. sarcoidosis, pulmonary fibrosis, Wegener’s granulomatosis, rheumatoid lung disease)
  • To determine the stage of a known lung cancer


Lung biopsy is a standard procedure. Your doctor will explain how the procedure is done, its benefits, risks and it need.

The different methods of performing a lung biopsy depend on the location of the abnormal tissue, the severity of the condition and the amount of sample tissue needed.

  • Bronchoscopic biopsy (Transbronchial biopsy): A process which involves viewing the lungs through the mouth or nose with the use of a Bronchoscope (lighted instrument). A needle is inserted to remove a sample tissue. This is recommended for a suspected infectious lung disease, lung tumour or serves as a primary procedure before an open lung biopsy is advised.
  • Needle biopsy (Transthoracic or Percutaneous biopsy): A process which involves using a long needle inserted through the chest or back to remove a sample of the abnormal tissue in the lungs. This is recommended if the mass or nodule is located near the chest wall. However, the sample taken may not be enough to make a diagnosis.
  • Open biopsy: An invasive method, which involves surgery by cutting between the ribs to remove a sample tissue from the lungs. This is recommended when a larger tissue is required for diagnosis or if other methods are unsuccessful or not recommended.
  • Video-assisted thoracoscopic surgery (VATS): A process which involves using an instrument called a thoracoscope (fibre-optic camera) which is inserted through a small cut on the chest wall to visually examine the lungs and remove a sample tissue.
  • Mediastinoscopy: Similar to VATS, but differs in the cut, which is made at the base of the neck and a thin, hollow, lighted tube called mediastinoscope is inserted between the two lobes to remove a sample tissue. This procedure may take an hour.


The possible complications of lung biopsy will depend on the method used, the area where the tissue is located and your overall health condition. These would include:

  • Bleeding of the lungs
  • Collapse of the lung caused by air leak (pneumothorax)
  • Irregular heart rhythms
  • Impaired breathing
  • Infection
  • High blood pressure
  • Reaction to anaesthesia
  • Leakage of air into the major arteries which is most common in needle lung biopsy

What to expect

You should inform your doctor if you:

  • have taken any medicines, which include blood thinners (anti-coagulants)
  • are allergic to any medicines and anaesthetics (especially in an open lung biopsy)
  • have bleeding problems
  • are pregnant

In preparation for the biopsy, your doctor will order certain laboratory tests such as complete blood count (CBC) and clotting factors. You will be advised to stop taking solid foods or fluids 6-12 hours before the surgery.


If the results reveal any nodules in the lungs, they may be caused by infections such as tuberculosis, or scars from previous infections. A mass or a nodule may be cancerous depending on certain factors. One of which is the size of the node.

However, if the results do not confirm infection or disease, you may be asked to wait and repeat the scan in a few months.


After a needle biopsy, you may be allowed to rest and will be monitored every 2 hours. You are to lie on your back to prevent bleeding. If there are no further complications, you will be allowed to go home, but advised to refrain from any strenuous activities for a week.

In open biopsy, VATS and mediastinoscopy, you will be observed in the recovery room and your temperature, blood sugar level, blood pressure and respiration will be monitored. If there are no complications, you will be transferred to your private room making sure that the chest tubes remain in place.

You may experience:

  • Grogginess
  • Sore throat
  • Pain from the incision site (avoid driving when taking narcotic pain medication)

Inform your doctor if and when you feel:

  • Extreme pain
  • Light-headedness
  • Difficulty breathing
  • Heavy or persistent bleeding