Finding out that you need a biopsy of your lungs or lymph nodes to test for lung cancer can feel overwhelming. Among many other tests and procedures for lung cancer, lung biopsies are essential for confirming if you have lung cancer and if so, what kind you have.

You may have many questions before your procedure. Will it hurt? How do I best prepare for it? What’s the recovery process like? This article shares insights on what to expect before, during, and after a lung biopsy.

Why and When Do You Need a Lung Biopsy?

There are many reasons why you may need a lung biopsy. For example, a lung biopsy is used to diagnose lung diseases or lung cancer.

In a lung biopsy, doctors carefully remove a tiny piece of lung tissue to examine it more closely for any medical concerns. Lung biopsies are usually performed to determine whether a lung mass is malignant (cancerous) or benign (not cancerous).

Doctors can use biopsies to learn additional details about cancer cells and to diagnose a specific type of lung cancer. Biopsy samples can even be tested for genetic mutations (changes) that allow doctors to choose treatments targeted to your specific disease.

Biopsies are often used along with imaging tests, such as positron emission tomography (PET) scans, X-rays, and CT scans, to make the most accurate diagnosis. “The PET scan is great in showing cancer in all areas they scan,” one member shared. “And the biopsy is a confirmation of the cancer.”

Knowing the stage of your lung mass — how large it is and how far it has spread — will help your doctor determine your prognosis.

Lung biopsies may also be used during treatment and later on in your lung cancer journey to check how effective your treatment has been and monitor for lung cancer recurrence. One MyLungCancer team member, 10 years in remission shared, “Yesterday’s CT scan showed a 10-centimeter mass in my left lung. Doctor says a CT-guided biopsy is next.”

Types of Lung Biopsy

Depending on the size, location, and appearance of your mass, your doctor will select the type of lung biopsy that will work best for you. The goal is to pick the easiest and least uncomfortable way to get a tissue sample. Your doctor will also keep in mind your general health and ability to undergo anesthesia.

Biopsies may not only come from your lungs — they may come from your lymph nodes, too. Lymph nodes are small, bean-shaped structures that are part of the lymphatic system, which is a part of your immune system. They are found throughout your body and help to filter harmful substances like bacteria and viruses.

Common biopsy types include:

• Needle lung biopsy
• Transbronchial lung biopsy
• Thoracoscopic lung biopsy
• Open lung biopsy
• Mediastinoscopy
• Liquid biopsy

Needle Lung Biopsy

A needle biopsy is a minimally invasive procedure that involves a thin needle to take tissue from the mass in your lung. The needle, in a technique often referred to as transthoracic or percutaneous, is inserted through the skin on your chest to reach the lung. The doctor knows where to put the needle by using a CT scan to guide the biopsy.

A needle biopsy is often done under local anesthesia (numbing the area, but keeping you awake) in an outpatient setting.

Transbronchial Lung Biopsy

With this method, a thin, flexible tube with a camera called a fiberoptic bronchoscope travels through the airway from your nose or mouth to your lungs. The bronchoscopy can allow the doctor to see your lungs from the inside and collect samples as needed.

Your doctor may decide to use either local or general anesthesia (putting you to sleep), and it can be done in the outpatient setting.

Thoracoscopic Lung Biopsy

Thoracoscopic biopsy, also called video-assisted thoracic surgery, is a more invasive form of lung biopsy. After you receive general anesthesia, a surgeon will guide a thin tube with a tiny camera, called an endoscope, through your chest wall. Using biopsy tools, the surgeon can take tissue for biopsy, or even remove a suspicious nodule entirely. They may decide to do a thoracoscopic biopsy if the tumor is otherwise difficult to access.

This procedure is done in a hospital setting and may require a short hospital stay.

Open Lung Biopsy

During an open lung biopsy, doctors will give you general anesthesia, make incisions along your chest, examine your lungs, and remove a piece of tissue. Specialists called pathologists will rapidly freeze the piece of tissue and study it under a microscope to look for signs of cancer. If cancer is found, doctors may perform more involved surgery at that time.

Because an open lung biopsy is a surgical procedure, you would need to stay in the hospital during and after the procedure while you’re recovering.

Mediastinoscopy

Instead of sampling a mass in your lung directly, a mediastinoscopy method samples the lymph nodes in your chest, which are behind your breastbone. This area between your lungs is called your mediastinum. This procedure is usually done under general anesthesia and may require a stay in the hospital.

Liquid Biopsy

A liquid biopsy is a sample of your blood that looks for genetic mutations. When tumor cells die, they release their DNA into your bloodstream. This DNA, called circulating tumor DNA or ctDNA, can be analyzed from a simple blood sample. It can serve as an important biomarker that can help your doctor better target your treatment.

This is the least invasive type of biopsy that may be done in an outpatient setting, in addition to a lung biopsy.

Preparing for a Lung Biopsy

The most important preparation you can do before a lung biopsy is mental and psychological. You’ll need to have a clear understanding of the procedure and what it will tell you. You can prepare by discussing any questions or concerns with your oncology team. Likewise, seek support from family, friends, and the MyLungCancerTeam community.

In terms of physical preparation, follow any guidance from your doctor about fasting or avoiding specific medications before your procedure.

On the Day of the Procedure

The details of your procedure depend on the type of biopsy you’re receiving. Needle biopsies and bronchoscopies are often performed on an outpatient basis under local anesthesia. This allows people to return home the same day.

On the other hand, more invasive procedures like an open biopsy or mediastinoscopy that involve general anesthesia may require you to stay in the hospital.

Before the Procedure

When you arrive for your procedure, your doctor will explain it to you, and you can ask questions. After reading and signing a consent form, your doctor may perform a history and physical exam on you to make sure you’re in good health before the biopsy. Before the procedure begins, let the doctor know if you are pregnant, have any allergies, and what medications you’re taking.

During the Procedure

How the biopsy is done depends on the kind of biopsy you’re getting. For an outpatient needle biopsy, the process will go something like this:

1. You will be asked to remove any jewelry and clothing and change into a gown.
2. A nurse may start an intravenous (IV) line in your arm or hand.
3. You’ll be asked to either sit or lie down, depending on what part of the lung needs to be sampled.
4. Your doctor may use a chest X-ray or CT scan to locate the site of the biopsy and mark your skin.
5. After cleaning your skin, the doctor or nurse will numb the biopsy site with a local anesthetic, which will sting briefly.
6. You’ll be asked to remain as still as possible during the procedure, to hold your breath when told, and to avoid coughing so that your doctor can access the precise location.
7. Your doctor will make a small incision and use a biopsy needle to enter your lung and collect the sample.
8. When the needle is taken out, your doctor may suture or apply adhesive strips to your skin to stop the bleeding and apply a sterile dressing.
9. You may undergo another chest X-ray after your biopsy is completed.

For more details on other kinds of lung biopsies, check out this guide by Johns Hopkins Medicine.

After a Lung Biopsy

Recovering from a lung biopsy depends on the type of procedure and how complex it was. Outpatient procedures may have a shorter recovery time. If you need to stay in the hospital, the recovery time will be longer.

Common postprocedure experiences include mild discomfort, bruising, or soreness in the area of the biopsy. If you had a biopsy through the skin, change your bandage when instructed to do so. If you underwent a transbronchial lung biopsy, you may have a sore throat. Your health care team will provide you with detailed guidance on managing pain and any potential complications.

All surgical procedures have risks. Some symptoms to look out for while you recover include:

• Chest pain
• Shortness of breath
• Pain while breathing
• Coughing up blood
• Fever or chills
• Swelling or drainage from the biopsy site

If you notice any of these symptoms, make sure to contact your doctor.

Waiting for Results

Waiting to get your lung biopsy results back can be one of the hardest parts of the lung biopsy procedure. One member said, “It took a month for them to evaluate my biopsy.”

However, at most facilities, the wait should only be a few days. Ask your doctor when you should expect your results, and ask questions in the meantime.

Next Steps

Depending on the results of your lung biopsy, you should return to your oncologist for follow-up, where you will discuss your treatment plan. One MyLungCancerTeam member shared the first steps of their journey: “The doctor ordered my PET scan and needle biopsy, and I’m on the road to begin radiation treatments in a couple of weeks.”

As you recover from your biopsy procedure and wait for more information, it’s important to rely on your support system and reach out for help when you need it.

Talk With Others Who Understand

On MyLungCancerTeam, the social network for people with lung cancer and their loved ones, more than 12,000 members come together to ask questions, give advice, and share their stories with others who understand life with lung cancer.

Have you ever gotten a lung biopsy for lung cancer? What advice do you have for others undergoing this procedure? Share your experience in the comments below, or start a conversation by posting on your Activities page.