Types of Lung Biopsy

What to expect when undergoing one of these tests

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A lung biopsy is a procedure to get a sample of suspicious lung tissue. By looking at a sample of tissue under the microscope, doctors can better determine what exactly is causing the abnormality, and whether the process is cancerous or not.

Doctor using endoscope
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Purpose of Lung Biopsy

With lung cancer, a lung biopsy is important in order to determine the type of lung cancer as well as the molecular or genetic profile of the tumor. There are several reasons a lung biopsy may be recommended:

  • To evaluate a nodule or mass seen on an imaging study of the chest, and to see if it is benign or malignant (cancerous).
  • To follow up on abnormal results of CT lung cancer screening.
  • To diagnose a lung infection. Lung infections could be bacterial (such as tuberculosis), viral or fungal (such as aspergillosis or coccidiomycosis).
  • To diagnose a lung disease such as sarcoidosis, pulmonary fibrosis, granulomatosis with polyangiitis or rheumatoid lung disease.
  • To do genetic testing (molecular profiling) on lung cancer. This testing looks for "targetable" gene mutations—that is, mutations in cancer cells that "drive" cancer, several of which now have treatments available.
  • To determine the type of lung cancer.
  • To help determine the stage of known lung cancer.

Different Lung Biopsy Procedures

Needle Lung Biopsy

In a fine needle lung biopsy, doctors place a long needle through your back and into your lung to get a sample of tissue.  This is done with the use of a CT scanner or ultrasound to help guide the needle to the appropriate location. A needle biopsy is the least invasive way to sample a suspicious region in your lungs, but it does not always get enough tissue to adequately make a diagnosis. A needle lung biopsy is also called a "transthoracic" biopsy or a "percutaneous" biopsy.

Transbronchial Biopsy

A transbronchial biopsy is done during a bronchoscopy, a procedure in which a scope is directed down from your mouth and into the upper airways of your lungs. With the help of an ultrasound (endobronchial ultrasound), physicians can then direct a needle into a suspicious area and obtain a sample (transbronchial needle aspiration.) This procedure is most effective when an abnormality or tumor is located in or near the large airways of the lungs.

Thoracoscopic Lung Biopsy

In a thoracoscopic lung biopsy, a scope is introduced through the chest wall and into the region of the lung to be biopsied. During a thoracoscopic biopsy, a video camera is used to help doctors find and biopsy the area of tissue. In this procedure, also known as video-assisted thoracoscopic surgery (VATS), doctors may also be able to remove an area of suspicious tissue or a lobe of the lung that is cancerous. (Note: They will not do this without discussing this with you before the procedure.)

Open Lung Biopsy

As the most invasive way to sample tissue, an open lung biopsy is sometimes necessary to sample tissue when other methods have failed. This is a major surgical procedure, done under general anesthesia. It may require separating the ribs or removing a portion of a rib to gain access to the lungs. Sometimes, an open biopsy is performed as part of surgery to remove a nodule or mass, especially if your surgeon is quite certain that you have cancer.

Liquid Biopsy

A liquid biopsy is an exciting new area being studied to evaluate lung cancer. This procedure, requiring a simple blood draw, looks for circulating cancer cells in order to evaluate tumor DNA for driver gene mutations—that is, mutations in the cancer cells for which specific treatments may be available. Sometimes when a lung biopsy is done, physicians are unable to extract enough tissue to perform this testing, and a liquid biopsy could make these results available without having to go after more tumor tissue.

In June 2016 the first liquid biopsy was approved for detecting EGFR mutations in people with non-small cell lung cancer.In general though, a tissue biopsy is preferred in the majority of cases.

Results of Your Lung Biopsy

If your doctor is able to get a good sample of tissue, you will likely hear about the results within two to three days—although this sometimes takes longer, especially if more than one pathologist wishes to review the results. It is helpful to ask your doctor at the time of the procedure when you can expect to hear your results, and if you will receive a phone call or if you have to make an appointment to learn of the results. Some physicians are comfortable calling you on the phone to let you know their findings while others may wish to set up a follow-up appointment to go over the results.

Though your doctor may have a good idea of what the findings will be, it’s not uncommon for physicians to be wrong after seeing a sample of tissue. The likelihood of an abnormality being cancerous depends on many factors, one of which is the size. Lung nodules (spots on the lung that are 3 centimeters [1½ inches] or less) are less likely to be malignant than lung masses (spots on the lung that are greater than 3 centimeters in size).

On occasion, a sample of tissue does not reveal a diagnosis. A report such as this may be returned as "inconclusive." If that is the case, there are still several options. If the likelihood is low that the abnormality in your chest is cancer, you may opt to wait and do a repeat scan in a few months. Similarly, even if the spot may be cancerous and having a precise diagnosis wouldn’t alter treatment, you may choose to wait.

If on the other hand, a diagnosis is important, you and your doctor may choose to repeat the biopsy or find a different means of obtaining a tissue sample. You can learn more about the difference between benign and malignant tumors and why making the distinction is sometimes difficult.

Molecular Profiling

It's important to note that everyone with non-small cell lung cancer should have gene testing (molecular profiling) done on their tumor. Talk to your doctor if you have not heard this discussed. Currently, medications are approved for those with ALK rearrangements, EGFR mutations, and ROS1 rearrangements and treatments for other targetable mutations are being done in clinical trials.


The risks of a lung biopsy vary depending on the type of procedure, the location of the tissue and your general health. The most common complications are bleeding or an air leak from your lung. Other possible complications include:

  • Pneumothorax: a collapse of the lung (air leak). If you develop a pneumothorax as a result of a biopsy, your surgeon will likely need to place a chest tube. This is a tube which allows air to exit your lungs until the air leak has sealed.
  • Bleeding
  • Infection
  • The Risk of Anesthesia: Both local anesthesia and general anesthesia can carry risks.
  • Systemic Air Embolism: A leak of air into the major arteries that can travel to the heart; referred to as systemic air embolism, occurs in less than one percent of needle lung biopsies.
  • Tumor "Seeding": There is a hypothetical risk that a tumor will spread along the track of the needle biopsy when a core biopsy is done. This risk is rare, and at the current time, needle biopsies are considered a very safe way to take a biopsy of the lungs when needed.

A Word From Verywell

Whatever the reason your doctor has recommended a lung biopsy, the uncertainty can be hard to cope with. Many people have said that they feel more at peace with a bad diagnosis than living in a state of not knowing.

Lean on your family and friends and this time. Reach out to people that you know will help you cope with the waiting, such as those who usually raise your spirits. This is also a good time to kindly ask your loved ones not to "diagnose" you until you know more, and to refrain from sharing their stories (what we call horror stories) about others who have faced something similar.

If your mind goes to the worst-case scenarios, keep in mind that medicine is always changing. If you do have the same diagnose your grandmother did years ago, it does not mean you will have the same experience. There were more new treatments approved for the treatment of lung cancer between 2011 and 2016 than during the 40 years preceding 2011.

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  1. National Institute of Health. Lung needle biopsy. Updated 03/09/17.

  2. Dietel, M. et al. Diagnostic procedures for non-small-cell lung cancer (NSCLS): recommendations of the European Expert Group. Thorax. 2015 Nov 3. (Epub ahead of print) doi:10.1136/thoraxjnl-2014-206677

  3. Yao, X. et al. Fine-needle aspiration biopsy versus core-needle biopsy in diagnosing lung cancer: a systematic review. Current Oncology. 2011. 19(1):e16-27. doi:10.3747/co.19.871

  4. National Institute of Health. Open Lung Biopsy. Updated 03/09/17.

  5. Zhang, A., Ramnath, N., and S. Nagrath. Current Status of CTC’s as Liquid Biopsy in Lung Cancer and Future Directions. Frontiers in Oncology. 2015. 5:209. doi:10.3389/fonc.2015.00209

  6. Jiang, T., Ren, S., and C. Zhou. The role of circulating-tumor DNA analysis in non-small cell lung cancer. Lung Cancer. 2015. 90(2):128-34. doi:10.1016/j.lungcan.2015.09.013

  7. Wu, C. et al. Complications of CT-guided percutaneous needle biopsy of the chest: prevention and management. AJR: American Journal of Roentgenology. 2011. 196(6):W678-82. doi:10.2214/AJR.10.4659

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