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Needle Biopsy of the Lung and Pleura

(Transthoracic Needle Aspiration; Percutaneous Needle Aspiration)

by Julie J. Martin, MS

Definition

A needle biopsy of the lung or pleura is done to remove a sample of lung or pleural tissue or fluid. Pleura is the lining of the lungs and chest wall. Once the tissue is removed, it will be examined in a lab.

Female Torso with Respiratory System and Ribcage (Anterior View)

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Copyright © Nucleus Medical Media, Inc.

Reasons for Procedure

This procedure is used to diagnose abnormal tissue in or around the lung. Possible reasons for abnormal tissue are:

Possible Complications    TOP

Complications are rare, but no procedure is completely free of risk. If you are planning to have a needle biopsy, your doctor will review a list of possible complications, which may include:

Factors that may increase the risk of complications include:

Make sure to tell your doctor if you are pregnant.

What to Expect    TOP

Prior to Procedure

Your doctor may order:

  • A complete physical exam
  • X-ray —a test that uses radiation to take a picture of structures inside the body
  • CT scan —a type of x-ray that uses a computer to make pictures of the inside of the body
  • Ultrasound—uses sound waves to make pictures of the inside of the body
  • Blood tests

Leading up to your procedure, do not start taking any new medicines without consulting your doctor.

You may be given pre-procedure medicines for certain conditions (eg, to suppress a cough).

Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:

  • Aspirin or other anti-inflammatory drugs
  • Blood thinners, such as clopidogrel (Plavix) or warfarin (Coumadin)

Anesthesia

  • You may receive a mild sedative about an hour before the procedure. It will help you relax.
  • You may also have an injection of a local anesthetic. It will numb the area where the needle will be inserted.

Description of the Procedure

Your skin will be cleaned with an antiseptic solution. You will be in a seated position, leaning forward, with your arms resting on a table for support. You should remain as still as possible. An ultrasound or CT scan will be used to locate the exact area.

A small cut will be made in your skin. Then, while you hold your breath, the biopsy needle will be inserted through the cut. The needle will be passed between your ribs until it reaches the lung or pleura. Your doctor then withdraws some cells through the biopsy needle. The needle will be withdrawn. Pressure will be put on the site of the incision. When the bleeding stops, a bandage will be applied.

How Long Will It Take?

Between 30-60 minutes

How Much Will It Hurt?

  • Before the procedure, when the local anesthetic is injected, you may feel a brief sting.
  • During the procedure, when the needle is inserted, you will probably feel some pressure. If you are having a lung biopsy, you will feel a quick, sharp pain when the needle touches your lung.

Post-procedure Care

At the Care Center

  • You may rest for several hours after the procedure. A nurse will check on you and monitor your recovery.
  • A few hours after the procedure, a chest x-ray or other imaging technique may be done. This is done to make sure a lung has not collapsed and that there is no bleeding.
  • If there are no complications after four hours, you may go home.

At Home

When you return home, do the following to help ensure a smooth recovery:

  • Rest at home for a day or two.
  • Avoid strenuous activities for one week.
  • You may remove the bandage after a day or two.
  • Ask your doctor about when it is safe to shower, bathe, or soak in water.
  • Be sure to follow your doctor's instructions.

Ask your doctor when to expect the results of the biopsy.

Call Your Doctor    TOP

After arriving home, contact your doctor if any of the following occurs:

  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
  • Pain that you cannot control with the medicines you have been given
  • Cough, shortness of breath, or chest pain
  • Coughing up blood
  • Pain when taking a deep breath
  • You feel your heart rate is fast

In case of an emergency, call for medical help right away.

RESOURCES:

American Cancer Society
http://www.cancer.org/
American Lung Association
http://www.lungusa.org/

CANADIAN RESOURCES:

Canadian Cancer Society
http://www.cancer.ca
Canadian Lung Association
http://www.lung.ca

References:

Beers MH, Fletcher AJ, Jones TV, et al. The Merck Manual of Medical Information: Second Home Edition . Whitehouse Station, NJ: Merck Research Laboratories; 2003.
Busick NP, Fretz PC, Galvin JR, et al. Transthoracic needle aspiration biopsy. Virtual Hospital website. Available at: http://www.vh.org . Accessed September 6, 2005.
Light R, Lee G (eds). Textbook of Pleural Diseases . London, England: Arnold; 2003.
Mason RJ. Murray & Nadel's Textbook of Respiratory Medicine . 4th ed. Philadelphia, PA: WB Saunders; 2005.
Murray JF, Mason RJ. Murray & Nadel’s Textbook of Respiratory Medicine . 4th ed. Philadelphia, PA: Saunders, 2007.
Ost D, et al. Clinical practice. The solitary pulmonary nodule. N Engl J Med . 2003;348:2535.
6/3/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/ : Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.
Last reviewed March 2013 by Marcin Chwistek, MD
Last Updated: 3/15/2013