Lung Biopsy

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You may be preparing for a lung biopsy after a lung cancer screening raised a cause for concern with your doctor.

While lung nodules are rarely lung cancer, the advantages of early treatment make testing many nodules worthwhile. To test the nodule, a small sample of tissue needs to be removed and examined under a microscope by a pathologist.

A biopsy can help pinpoint the cause of a lung nodule, mass or other pulmonary condition. Other conditions that may require a biopsy include sarcoidosis, interstitial lung disease, infection and types of pneumonia.

Depending on your condition and the location of the tissue to be sampled, a biopsy can be performed in number of ways, ranging from a needle biopsy, under sedation, to surgery or a minimally invasive robotic-assisted bronchoscopy. Once the sample is taken, it is examined by pathologists to help your physician make a diagnosis.

Robotic-assisted Bronchoscopy 

Norton Healthcare pulmonologists, oncologists and others use robotic-assisted bronchoscopy to reach more parts of the lung with greater precision to collect samples from lung nodules and other tissue. In some cases, the tissue can be evaluated and the mass removed during the procedure. This can relieve you of having to wait for test results, then schedule another procedure.

Before the development of minimally invasive robotic-assisted bronchoscopy, many nodules required surgical biopsies. With the minimally-invasive procedure, more nodules can be tested, and we have more opportunity to catch lung cancer at a very early stage when it’s most treatable.

Robotic-assisted bronchoscopy can reach every part of the lung, including the periphery — the very ends of tiny air passages or in tissue outside the passage — where about 70% of lung nodules develop.

The robotic system uses a thin tube just more than one-eighth inch wide with a camera. Your physician can pass tiny tools through the tube to the biopsy site. This thin tube, or catheter, is passed through your throat and can maneuver in tiny spaces that conventional bronchoscopes can’t reach. 

You’ll have a larger tube inserted in your mouth to provide a pathway for the robotic bronchoscope while you’re under general anesthesia.

Using a CT scan taken before your procedure, your surgeon will have 3-D map to plan the catheter’s pathway. The physician steers the bronchoscope through the passageways, guiding it from a control panel. A monitor shows the catheter’s progress and surrounding structures. Once at the site of the mass to be biopsied, the robotic bronchoscope uses shape-sensing technology to remain stable while the appropriate tools are passed through to collect tissue samples.

Norton Healthcare has the capability to examine tissue samples immediately, and if cancer is detected, a separate robotic-assisted procedure allows for removal of the mass while you’re still asleep. 

Conventional bronchoscopes continue to be used for biopsies in more accessible parts of the lung and other airway examinations. 

If robotic-assisted bronchoscopy is right for you, your physician will perform the procedure at either Norton Hospital in downtown Louisville or at Norton Audubon Hospital. 

Lung Needle Biopsy

A needle biopsy of the lung is also known as a percutaneous transthoracic lung biopsy (PTLB). You’ll be awake, but sedated and under a local anesthesia as a needle is inserted through the chest into the lung with guidance from a CT scan or other real-time imaging. Once at the tissue site that is concerning, the needle is used to collect a sample and withdrawn. 

Open Lung Biopsy

An open lung biopsy is a surgical procedure under general anesthesia. Your surgeon will cut into your chest and likely insert a small camera between the ribs. Once tissue is located and removed, it will be examined by a pathologist. A breathing tube will be in place throughout the surgery.

Video-assisted Thoracic Surgery

Thoracic surgeons may use an endoscope to remove lung tissue through an incision in the chest. Your surgeon inserts a small tube through an incision between your ribs. A tiny camera on the end of the tube helps the surgeon see the entire chest cavity and find the tissue to be removed. Special instruments inserted through another tube collect the tissue for testing by a pathologist.

Transbronchial Biopsy

In this procedure, the doctor uses a flexible bronchoscope inserted through the mouth or nose while you are under general anesthesia. This is typically used for lesions that are more easily accessed.


In this procedure, which is similar to a transbronchial biopsy, the tissue is frozen using nitrous oxide and removed.

Why Choose Norton Cancer Institute

More patients in Louisville and Southern Indiana choose Norton Cancer Institute than any other provider in the area. We provide compassionate care for the whole person, not just the cancer.

Our Norton Cancer Institute oncologists are also researchers and principal investigators, offering patients sophisticated experience in the latest treatments and access to more than 200 clinical trials.

  • Access to more than 100 specialists, including board-certified and fellowship-trained oncologists
  • Multidisciplinary setting, meaning you get the benefit of opinions from multiple specialists across Norton Healthcare and often can schedule appointments for the same day in the same location
  • Immunotherapies such as CAR-T cell therapy, genetic therapies tailored to combat the unique genetic makeup of your cancer and the latest in surgical treatments, chemotherapy and radiotherapy
  • State-of-the-art Norton Cancer Institute Genomics Lab offering highly specialized testing that makes it possible to tailor advanced treatments based on a tumor’s specific genetic composition
  • Robotic-assisted bronchoscopy for minimally invasive lung biopsies that can reach more parts of the lung without major surgery
  • Medicare, Medicaid and most major commercial insurance accepted
  • At Norton Specialty Pharmacy, patients receive regular consultations on their medications and treatment plan, making sure they get their prescriptions quickly and accurately. Our specialty pharmacists collaborate closely with your oncology team.
  • Use your free Norton MyChart account to communicate with your provider, manage appointments, refill prescriptions, get on the wait list for an earlier appointment and more anytime from a mobile device or computer

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