This information is intended to help provide you and your relatives with an understanding of your planned procedure. The procedure will also be thoroughly explained to you in person on the day of your appointment.
Why biopsy the lung?
Your doctor has referred you to Canberra Imaging Group (CIG) for a needle biopsy of an abnormality (lesion) in your lung. They have concluded that this is required in order to ascertain what has caused the abnormality which has been detected on a CT scan or Chest X-Ray. The results will help decide which treatment is necessary.
This is a relatively safe and commonly performed procedure. Minor risks include local infection or bleeding related to the passage of the needle through the skin and potential allergy to local anaesthetic. The major risks are detailed below and will be discussed with you by the Radiologist prior to beginning the procedure.
- Pneumothorax (collapsed lung)
A pneumothorax occurs when air leaks out of the lung through the hole created by the needle. A minor air leak occurs very commonly, resolving without the need for treatment. If treatment is required, it will involve sucking or draining the air out through a needle or small tube placed under local anaesthetic. Occasionally admission to hospital is required to make sure the leak from the lung has stopped and the lung is functioning properly.
The risk of a pneumothorax occurring is approximately 1 in 3* but the chance of requiring admission to hospital for treatment is only about 1 in 100.
CT allows the needle path to be planned to avoid major blood vessels. It is inevitable that small blood vessels will be traversed by the needle, resulting in 1 in 4* patients coughing up a small amount of blood during or immediately following the procedure. Life threatening bleeding is extremely uncommon.
- Air Embolism
This is an extremely rare occurrence in which air enters the arterial blood circulation, potentially causing a heart attack or stroke. Air embolism is an extremely rare complication.
To minimise these risks it is important that you do not move or cough at any time during the procedure, and follow instructions given by the Radiologist. Breathing should be shallow to minimise movement of the lesion and the Radiologist may ask that you hold your breath for up to 10seconds at a time during the procedure.
Your referring doctor has carefully considered these risks and determined that they are outweighed by the diagnostic benefits of the procedure. The benefit to you will be in obtaining a diagnosis of your chest problem so the correct treatment may be prescribed.
Prior to your Appointment
A CIG Nurse will contact you by phone several days prior to the procedure and provide specific preparation instructions. These instructions may vary person to person but generally include:
- Ceasing any blood thinning medications
- Attending a pathology lab to have a blood sample taken
- Arrival time
- Fasting requirement
How is the biopsy performed?
A Radiographer will collect you from the waiting area and discuss the procedure in detail. You will be asked to sign a consent form indicating that you wish to proceed with the biopsy at that time.
After changing into a hospital gown you will have a small needle (cannula) placed into a vein in your arm. Some planning images/scans will then be taken to identify the target lesion, which will be done whilst lying on your back, side, or front depending on the location of the lesion – it is very important that you do not move from the time these images are taken to commencement of the biopsy. The Radiographer will put a mark on your skin where the needle will be inserted.
The Doctor (Radiologist) will explain the procedure and answer any questions you may have prior to beginning the biopsy. Your skin will be cleaned with some antiseptic and local anaesthetic injected which will sting momentarily.
A needle will be inserted between the ribs and pictures taken as the needle is advanced to ensure accuracy. You may feel a pushing sensation during this process and some discomfort. When the images confirm that the needle is within the lesion a small piece of tissue will be removed by the needle and placed into a specimen container. Usually 2-3 samples are obtained in this manner. The biopsy specimens are then sent for laboratory analysis.
The biopsy itself will usually take between 10-15 minutes to complete. The whole process, including planning scans and marking, takes 25-30 minutes.
After the procedure
You will be transferred onto a bed and required to lie still for 1-2 hours. A chest X-Ray will be taken and assessed by the Doctor who performed the procedure. If everything looks fine you will be allowed to go home. You must have somebody available to drive you home and remain with you overnight. If you have travelled from outside the ACT region for the procedure you may be required to stay overnight in Canberra – this is to ensure you have access to emergency medical facilities nearby should any complications arise.
Some bruising and chest discomfort is normal following the procedure, however, if you experience sudden chest pain, bleeding, or suffer shortness of breath you must attend the nearest hospital Emergency Department.
If after returning home following the procedure you have any questions or concerns, please contact the CIG nurse directly on 02 6203 2073 during business hours (8.30am to 5pm).
* Wu,C. Maher, M. Shepherd. J 2010, ‘Complications of CT-Guided Percutaneous Needle Biopsy of the Chest: Prevention and Management’, AJR, Vol 196, June 2011, pp. 679-682