Needle biopsy of lung or pleura (guided by ultrasound or CT scanner) Turnberg Building Respiratory Medicine 0161 206 4039 Page 1 of 6 Document for issue as handout. Unique Identifier: MED23(18). Review date: May 2020
What is a Computer Tomography (CT) scan (or ultrasound scan) guided lung / pleural biopsy and why might I need this procedure? You have been advised to have a needle biopsy of the lung tissue or tissue lining the outside of the lung (pleura) to try to identify the cause of an abnormal area of lung tissue seen on your chest x-ray or CT scan. This test will be undertaken in the Imaging Department of the hospital, using either a CT scan or an ultrasound scan, to guide the procedure. The procedure will be undertaken by a specialist called a Radiologist. The specialist will pass a needle between two ribs (under local anaesthetic) and the needle will take a tiny sample from the area of abnormal lung tissue. Your own doctor and the radiology specialist will be happy to answer any questions which you may have about the procedure or the reason for undertaking the procedure. Are there any alternatives to CT (or ultrasound) guided lung biopsy? The radiologist will advise whether it would be best to use a CT scanner or an Ultrasound probe to guide the biopsy. In some cases we can use bronchoscopy to obtain lung tissue - please ask for our leaflet about bronchoscopy (this involves passing a small plastic telescope into the airways). Another alternative is to have a surgical biopsy under general anaesthetic. What will happen if I decide not to have a CT (or ultrasound) guided lung biopsy? The alternatives are described above. If you decide to have none of these procedures, your doctor may not be able to diagnose your lung condition or to provide you with the correct treatment for your condition. If you decide not to have this test, you should discuss this decision carefully with your doctor. Page 2 of 6
Will I need sedation or an anaesthetic for the test? Prior to the procedure, you will have a local anaesthetic injection around the area where the needle or cannula is to be inserted. You will not require a general anaesthetic. Ideally we prefer to avoid sedation as you will need to follow instructions on breathing and breath holding during the test. The vast majority of patients manage very well without sedation but if you are very anxious, we can arrange for you to have a mild sedative before the test. Please discuss with your doctor if you wish to have sedation so that we can arrange for this to be given. It must be given on the ward before you attend the scanning unit for the test. If you do wish to be sedated, please arrange for someone else to accompany you as you go home and avoid alcohol for the rest of the day. Do not go to work or operate machinery or sign any important documents if you have been sedated. The sedation will have fully worn off by the following day. What does the procedure involve? The radiologist will confirm the best site for the biopsy using an ultrasound scanner or CT scanner. You will probably have had a CT scan previously in the same scanner. If the radiologist uses ultrasound, this involves the use of a small probe with jelly on your skin surface and you will see pictures on a TV monitor. The needle will pass into the lung guided by the CT scanner or an ultrasound scanner and a small piece of tissue will be sampled. Usually three (but sometimes more) biopsies may be required to obtain an adequate specimen. The radiologist will give you clear breathing instructions throughout the procedure. Is the procedure painful? The local anaesthetic injection and the biopsy procedure may cause some local discomfort but most people find that any discomfort is mild. In the unlikely event that you develop a small leakage of air inside the chest (pneumothorax), you may experience mild discomfort when you take a breath (please see section on possible side effects on page 4). Do I need to avoid eating and drinking before the test? You may have a light early breakfast, but no food for 4 hours before the test. Clear fluids (not containing milk) can be drunk up until 2 hours before the test. If you have diabetes, please discuss your diabetes control with Hospital staff or Diabetes Nurses. Once the radiologist has identified the best site for the biopsy, you will have a local anaesthetic injection at the site of the procedure to make the area numb. When the area is numb, the radiologist will pass a small needle between the ribs. Page 3 of 6
What about taking my tablets (including warfarin or diabetic medications) before the test? If you are on warfarin, clopidogrel, aspirin or other blood thinning medications ( for example: Apixiban, Rivoroxaban, Dagabatran) or blood thinning injections please discuss this with your doctor. It is likely these will need to be suspended for a short period of time before the test. The doctor will be able to advise you when to suspend the medications and whether any additional precautions are required whist the blood thinning medications are being suspended. If you have been on warfarin you will need a blood test before the day of the biopsy to check your blood clotting. If you are diabetic, please discuss your diabetes medications with Hospital staff or Diabetes Nurses. Take all other medications (including tablets and inhalers etc) at the usual time of day on the day of your test. These can be taken with a sip of water until just before the procedure. Pre-procedure checks: Prior to the biopsy a Nurse will record your vital signs including blood pressure and pulse. Occasionally the results suggest that there is a problem which may require treatment. The doctor will then make a decision about whether or not it is safe to proceed. Occasionally it is best to cancel the procedure until the problem has been fixed. Before the biopsy is undertaken, a scan is done. Sometimes this scan detects that the lesion of interest has reduced in size and under these circumstances the doctor is likely to advise you that a biopsy is no longer required. What are the possible side-effects and complications of CT or ultrasound guided lung biopsy? It is necessary to lie still in the scanner for up to 30 or 40 minutes while the procedure is undertaken. You may be asked to lie on your front, on your back or at an angle, while keeping as still as possible. Some people may find this uncomfortable. Needle biopsy of the lung is usually a very safe procedure unless you have got severe lung disease. If this was the case, the additional risks would be explained to you. The risk of death from the procedure is estimated to be about one per thousand but this risk is much lower for most people and higher for people with severe lung disease. A risk of one per thousand is equivalent to the risk of a fatal accident if you were to drive 220,000 miles. Some people (around 5%) cough up a few spots of blood after this procedure and it is possible to have some bleeding at the biopsy site but serious bleeding is very uncommon. It is common to have a small leakage of air inside the chest (pneumothorax) following this procedure. This can occur in 25-30% of procedures, however, this is usually very small and in most cases requires no intervention although you may have to stay in hospital overnight for observation. If the pneumothorax is larger and causing symptoms it may require treatment. This is done by putting a small plastic drain between two ribs (chest drain). Chest drains may be required in 5-10% of procedures and you will require a short hospital stay until the pneumothorax is resolved. Page 4 of 6
What happens after the procedure? After a lung biopsy, we recommend that you rest quietly for 2 hours after the biopsy. This is to reduce the chance of pneumothorax (air leak). If you are a hospital inpatient, you will return to your ward and the nurses will perform some routine observations for a few hours to screen for any complications from the biopsy. If you are an outpatient, you will be observed on the Programmed Investigation Unit (PIU) for a few hours. You will have a chest X-ray about 2 hours after the biopsy. You may require a second chest x-ray after a further 1-2 hours before being discharged home. What happens when I go home? We advise you not to drive on the day of the procedure. When you get home you can eat and drink as normal. You should rest until the next day. There should be someone with you at home overnight in case you develop any side effects. If this is not possible, please discuss this with your doctor as we may need to arrange a hospital bed for you. You will be advised to attend the Emergency Department of your nearest hospital if you should feel significantly more short of breath than usual at any time in the first 24 hours after this test. You should be able to go back to work the day after a biopsy, unless otherwise advised. We recommend that you do not go on any air travel for at least 1 week following a lung biopsy. When will I get the results of the test? The biopsy results can take several days to be ready. These will be discussed with you at the clinic if you are an outpatient or on the ward if you are an inpatient. If you have not heard any news within 10 days of your biopsy, please contact your consultant s secretary for further advice. Your doctor will advise you about the chance the biopsy will provide a diagnosis. For the more straightforward biopsies a diagnosis is usually achieved in up to 90% of cases but for the more difficult biopsies this may be as low as 50%. Further Information: If you require any more information about this test, please ask your doctor or any member of the health care team about the test. The chest team can be contacted on: You will be asked to sign a consent form once you have read this document and your questions have been answered. For further information on this leaflet, it s references and sources used, please contact: or Email: 0161 206 4039 0161 206 4039 marcia.gowenlock@srft.nhs.uk Page 5 of 6
You can get further information from: NHS 111 Service when less urgent than 999 111 NHS Direct www.nhsdirect.nhs.uk British Lung Foundation 03000 030 555 or on their website: www.blf.org.uk/home This document is intended for general information purposes only and you should read it together with (and depending on) any advice given by your relevant health professional. NOTE FOR MEDICAL STAFF: Needle lung biopsy procedure requires WRITTEN consent. Please give the patient an opportunity to study this document and discussing the procedure before undertaking consent and clearly document in the case notes/epr that written consent has been obtained. File a copy of this document and the signed consent form in the case notes as a record of what the patient has been told about the test. For further information on this leaflet, it s references and sources used, please contact 0161 206 4039 Copies of this leaflet are available in other formats (for example, large print or easyread) upon request. Alternative formats may also be available via www.srft.nhs.uk/for-patients/patient-leaflets/ In accordance with the Equality Act we will make reasonable adjustments to enable individuals with disabilities to access this service. Please contact the service/clinic you are attending by phone or email prior to your appointment to discuss your requirements. Interpreters are available for both verbal and non-verbal (e.g. British Sign Language) languages, on request. Please contact the service/ clinic you are visiting to request this. If you need this information leaflet translated, please telephone: or Email: InterpretationandTrans@srft.nhs.uk Under the Human Tissue Act 2004, consent will not be required from living patients from whom tissue has been taken for diagnosis or testing to use any left over tissue for the following purposes: clinical audit, education or training relating to human health, performance assessment, public health monitoring and quality assurance. If you object to your tissue being used for any of the above purposes, please inform a member of staff immediately. Salford Royal NHS Foundation Trust Stott Lane, Salford, Manchester, M6 8HD Telephone 0161 789 7373 www.srft.nhs.uk If you would like to become a Foundation Trust Member please visit: www.srft.nhs.uk/ for-members Salford Royal operates a smoke-free policy. For advice on stopping smoking contact the Hospital Specialist Stop Smoking Service on 0161 206 1779 This is a teaching hospital which plays an important role in the training of future doctors. The part patients play in this process is essential to make sure that we produce the right quality doctors for all of our futures. If at any time you would prefer not to have students present please inform the doctor or nurses and this will not affect your care in anyway. If you have any suggestions as to how this document could be improved in the future then please visit: http://www.srft.nhs. uk/for-patients Page 6 of 6