Percutaneous lung biopsy

About a percutaneous lung biopsy

A percutaneous (through the skin) lung biopsy is a way of taking a small piece of tissue from your lung using a needle. To take the sample, we use a local anaesthetic which will sting slightly, but the area of the biopsy will soon be numb.

Your biopsy will take place in the Kingston Hospital CT scanning department. Occasionally we use ultrasound instead of CT scanning.

A CT scan uses X-rays and a computer to create detailed, cross-sectional images of the inside of your body. Ultrasound uses sound waves to create medical images.

A radiologist will perform your biopsy. This is a specialist doctor trained to use imaging-guided procedures. Radiographers (who use imaging technology) and nurses will also be present to support you.

A laboratory pathologist will then examine your lung sample under a microscope to help make a diagnosis. A pathologist is a doctor who examines cells, tissues, and fluids from the body to help diagnose and treat illnesses.

Why we recommend a lung biopsy for you

Our scans (such as a CT scan) have shown an abnormal area in your lung. A biopsy is the simplest way for us to find out what the area is and whether you need further treatment.

We believe that a CT-guided lung biopsy is the safest way for us to get a sample of your lung tissue to test.

Risks and complications

Most patients do not experience significant problems.  Possible risks are the following.

• A small bruise at the needle site. This usually disappears within a few days.
• Pneumothorax (a small air leak in the lung). This is very common. It happens to about 1 in 5 patients. It often heals by itself. About 1 in 20 patients may need to stay in hospital overnight so we can remove the air with a tube (a chest drain).
• Bleeding. This is common. About 1 in 20 patients cough up some blood. This can happen for up to 7 days after a biopsy. It may worry you, but it is important to stay calm. If bleeding continues, let your respiratory (lung) doctors know at your follow-up appointment. This usually takes place a few days after your biopsy.
• Serious internal bleeding. This is uncommon. It happens in about 1 in 1,000 procedures and may require an operation to stop the bleeding. 
• An air embolism (air entering the blood circulation). This is very rare. It happens in about 1 in 3,000 procedures and can potentially lead to a stroke or heart attack. This is rare.
• Death. This is extremely rare. There is a risk of dying either directly due to the procedure or treatment, or from complications over the following days or weeks. The risk depends on many factors. These include your age and underlying medical problems you may have.

Preparing for your biopsy

We perform most biopsies as outpatient procedures. Sometimes we ask people to stay overnight.

To prepare for your biopsy, do the following.

• Have a light breakfast before 6 am on the day of your procedure. Do not eat after 6 am, but you can have sips of water.
• Continue taking your usual medicines, except blood-thinning drugs, unless we tell you otherwise.
• Let us know as soon as possible if you have allergies or have had a reaction to contrast dye in the past. During a biopsy, we may use contrast dye to improve the quality of the images we take.
• We will give you a blood test before your procedure, to check your blood clotting reaction.
• If you are aged 18 to 55 and could be pregnant, we may ask you to take a pregnancy test before the procedure.

On the day

When you arrive at the Kingston Hospital Rowan Bentall X-ray department, your radiologist will explain the risks and benefits of the procedure. They will ask you to sign a consent form. We will not perform the procedure without your consent.

• We will ask you to change into a hospital gown. 
• We will check your blood pressure and pulse.
• We may put a thin tube (a cannula) into a vein in your arm so we can give you IV (intravenous) medicines.

The procedure

The procedure takes 30 to 60 minutes.

• We will take you into the CT scanning room and make you comfortable.
• It is important that you do the following during the scan:
  • lie still
  • follow our breathing instructions
  • try not to cough.
• We will clean and numb the skin at the site of the biopsy, using an injection of local anaesthetic.
• The radiologist will use the CT scanner to guide a needle into the abnormal area of your lung. They will take small tissue samples. They usually take 2 or 3 samples.

Pain

The local anaesthetic will sting briefly, but the area will soon feel numb.

You may feel some pressure or pushing during the biopsy.

If you are uncomfortable, let the nurse know.

Immediately afterwards

• You will stay in hospital for about 2 hours after the biopsy.
• Nurses will check your pulse, blood pressure and breathing.
• We will give you a chest X-ray before you go home.
• We will let you know when it is safe for you to eat and drink.

Recovery afterwards

Follow this guidance after your biopsy.

• Arrange for someone to drive you home and stay with you overnight.
• Rest at home for the remainder of the day.
• For 24 hours, avoid heavy lifting, shopping, exercise, sexual activity, alcohol, driving or operating machinery.
• You can gradually return to normal activities on the day after your biopsy.
• Do not fly for at least 7 days after your biopsy (or longer, if you experience complications).
• We will let you know when you can restart your blood thinning medicine.

Wound site

• For 24 hours, keep the plaster on and keep the wound site dry.
• Take paracetamol if you have mild discomfort.
• If the biopsy site bleeds, gently press a flannel or small towel onto the site for 10 minutes. If the bleeding continues, go to your GP or nearest Emergency Department (A&E).

When to seek further medical help

Go to your nearest Emergency Department (A&E) if you experience any of the following:

• sudden or severe chest pain
• difficulty breathing or shortness of breath
• coughing up large amounts of blood
• feeling faint or unwell.

Results

We will send your biopsy sample to a laboratory. We usually receive results within 7 days. 

We will discuss your results with you at your follow-up appointment. The respiratory team will contact you to arrange this appointment. It usually takes place about a week after your scan.