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Image-Guided Lung Biopsy

Image-Guided Lung Biopsy - What it is

Lung nodules or tumours detected on imaging (x-ray, computed tomography) can be a diagnostic dilemma.  A small piece of tissue can be removed from the abnormal lung lesion to make a diagnosis.  This procedure is called a biopsy.
One of the causes of lung nodules is lung cancer, which is the uncontrolled growth of abnormal cells in one or both lungs. It is the second most common cancer in men and third most common in women in Singapore.

Image-Guided Lung Biopsy - Symptoms

The most common symptoms of lung cancer include:
  • Cough (persistent or worsening)
  • Blood in sputum (haemoptysis)
  • Shortness of breath
  • Wheezing (whistling sound when you breathe)
  • Chest pain, especially if worse with deep breathing or coughing
  • Voice hoarseness
  • Headache and swelling of the face, arms or neck (tumour compression on superior vena cava)
  • Arm/ shoulder pain, droopy eyelid, smaller pupil, reduced or absent sweating on the same side of the face (tumour in the top part of the lungs- Pancoast tumour)
  • Weight loss, loss of appetite, night sweats and/or unexplained fever

Image-Guided Lung Biopsy - How to prevent?

Not all lung cancers can be prevented.  But you can control your risk factors.  
Also, early stage lung cancer, if diagnosed promptly with biopsy, may benefit from potentially curative treatment.

Image-Guided Lung Biopsy - Causes and Risk Factors

There are known risk factors that may increase your chance of developing lung cancer:
  • Smoking
  • Exposure to second-hand smoke
  • Exposure to cancer-causing chemicals (biomass fuel used for cooking, industrial chemicals such as asbestos, arsenic, and fumes from nickel and chromium)
  • Increasing age
  • Personal history of cancers (prior radiation theratpy to chest region) or lung diseases (chronic obstructive pulmonary disease, pulmonary fibrosis)

Image-Guided Lung Biopsy - Diagnosis

If your chest x-ray or computed tomography (CT) shows an abnormality that could be cancer, a biopsy can be performed to check for both cancer as well as other diseases.

Other tests that might be used to evaluate for lung cancer:
  • Sputum cytology
  • Bronchoscopy 

Image-Guided Lung Biopsy - Treatments

Biopsy can be performed in one of several ways:
  • CT guided biopsy- the tumour is localised with CT and a small needle is inserted through the skin to remove tissue from the tumour
  • Bronchoscopy- a flexible tube with a camera is inserted through your nose/ mouth and into the windpipe to access the tumour for biopsy
  • Surgery- remove the tumour lesion entirely

Image-Guided Lung Biopsy - Preparing for surgery

Before proceeding with lung biopsy, we will perform a clinical assessment which includes reviewing your medical history, blood tests (clotting times and blood count) and imaging test.  

If you are on any blood-thinning medications (antiplatelet and/or anticoagulant), you will be advised on the appropriate timing to stop them.  On the day of the procedure, you will be fasted for 4-6 hours prior to the time of the planned procedure. 

During the procedure, it is important to try to lie still, breathe gently and not cough.  Local anaesthetic is given to numb your skin before a thin needle is passed into the lung.  The local anaesthetic injection may sting initially but this will soon pass.  You may feel a pushing sensation when the actual biopsy is performed.  The procedure usually takes approximately 30-45 minutes.

Image-Guided Lung Biopsy - Post-surgery care

After the biopsy, a small dressing will be applied over the needle puncture site.  You will be monitored for at least 4 hours in the ward, and will be discharged by the following day if you remain well.  Most patients can resume normal daily activities on discharge.  

Chest x-rays, will be routinely performed after your biopsy to monitor for common potential complications- pneumothorax (air inside the chest but outside the lungs), bleeding.  If significant, these may require further evaluation with CT and/or extra procedures.  A chest tube may become necessary during or after the biopsy if the pneumothorax is enlarging or causing symptoms (such as breathlessness). In the event of uncontrolled bleeding, ‘blocking’ agents can be injected through the supplying artery to arrest the bleed. 

Medical attention should be sought if you have shortness of breath, chest pain or blood in sputum after discharge.

Image-Guided Lung Biopsy - Other Information

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