Lung Biopsy

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You may be preparing for a lung biopsy procedure 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 sarcoidosisinterstitial 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 tissue 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 abnormal lung tissue 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-assisted 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 bronchoscope while you’re under general anesthesia. 

Using results from a CT scan taken before your procedure, your surgeon will have 3D 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 bronchoscope system 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 under anesthesia. 

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. You’ll be awake, but sedated and under a local anesthesia for a PTLB as a biopsy 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 Biopsy

An lung open 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 the diseased 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.

Results of a Lung Biopsy Procedure

When samples are collected from your lung during a biopsy or cytology procedure, they are sent to a lab. A specialist called a pathologist will examine the tissue carefully and create a report. The report shows what type of lung cancer you may have (for example, small cell carcinoma). Abnormal results may require you to have further testing. Results are also used to plan treatment.

Other information on your pathology report includes:

  • The type of cancer you have
  • Findings of pre-cancerous cells that are not lung cancer but could turn into cancer if left untreated
  • Margins, which helps the pathologist see if there are pre-cancerous cells near where the tissue was removed, or if there are any cancer cells left behind
  • Noncancerous changes to the lung tissue caused by conditions such as emphysema

Make an appointment with your health care provider if you are at risk for developing lung cancer. Consider stopping smoking and making other lifestyle changes to prevent lung cancer. 

Lung Cancer Care for the Whole Person

Our Norton Cancer Institute Comprehensive Lung Center uses a multidisciplinary team approach. Our center allows you to see your oncologist, surgeon, radiation oncologist, counselor, nutritionist and other members of your care team all in one visit. No other facility in town offers the same seamless care. We have four dedicated patient navigators who manage day-to-day details and patient appointments. Specialists include pulmonologists, medical oncologists, radiation oncologists, thoracic surgeons and support services (dieticians, etc.). All our oncologists subspecialize in lung cancer. Our teams attend tumor boards to determine the best plan of care for your specific case. Patients often can get into the clinic within days of a referral to the Comprehensive Lung Center.

We offer state-of-the-art diagnostic tools and treatment techniques, including ultrasound, MRI and biopsies. Biopsies are done with minimally invasive robotic-assisted bronchoscopy. Targeted molecular therapies are used for certain subtypes of lung cancer. Other treatments include immunotherapy and biologic therapies designed specifically to target the genetic makeup of your cancer.

In addition to our current leading-edge treatments, we offer our patients the opportunity to participate in innovative National Cancer Institute- and industry-sponsored clinical research studies.

Five Norton Cancer Institute Resource Centers in Louisville and Southern Indiana offer a variety of support services that address the emotional, physical and spiritual needs of patients and their families. Specially trained oncology nurses also are on hand to provide one-on-one counseling. Patient resources offerings range from wigs to massage/music/art therapy, support groups and the Norton Cancer Institute Sexual Health Program. We take care of not just the body, but the person within.

Norton Cancer Institute is part of the first health system in Kentucky to become a GO2 for Lung Cancer Center of Excellence in both care continuum and screenings. This designation reflects the use of:

  • A patient-centric, collaborative care model that means patients can see an oncologist, surgeon, radiation oncologist, counselor, nutritionist and other members of their care team all in one visit
  • The most effective diagnostic and therapeutic technologies and techniques available

Medicare, Medicaid and most major insurance plans are accepted.

Communicate with your care provider, renew prescriptions, make appointments and get alerted if an earlier appointment becomes available through your free Norton MyChart account.

Norton Cancer Institute has multiple outpatient locations and infusion centers in Louisville, in surrounding counties in Kentucky and in Southern Indiana. We have multiple radiation centers located just off major interstates, with free self-service parking and valet parking.

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