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Needle Biopsy of the Lung, Pleura, Mediastinum, or Adrenal Glands

This information explains what to expect from a needle biopsy of the lung, pleura, mediastinum, or adrenal glands.

Introduction

A biopsy is a procedure to obtain a sample of tissue from the body. The sample is sent to the laboratory for testing to see if there are any abnormal cells. A percutaneous (per-cue-tā-nee-us) biopsy is one done through the skin; it does not require surgery. The doctor who does the procedure is an interventional radiologist. CT scan, MRI, ultrasound, or fluoroscopy is used to locate the exact area to be biopsied. These help the doctor place the biopsy needle in the exact place.

The figure shows the areas that may be biopsied:

  • Lung
  • Pleura - a thin, fluid-filled covering that protects your lungs
  • Mediastinum - the tissue and organs in the chest area between your lungs
  • Adrenal glands - glands that sit on top of your kidneys, high in the abdomen

Figure 1 Figure 1

Before Your Procedure

  • You may have to stop certain medications before your procedure. The card Common Medicines Containing Aspirin and Nonsteroidal Anti-Inflammatory Drugs has detailed information about these medicines.
  • Ask your doctor what to do if you take blood thinners such as:
    • Warfarin (Coumadin®)
    • Dalteparin (Fragmin®)
    • Enoxaparin (Lovenox®)
    • Heparin
    • Clopidogrel (Plavix®)
    • Cilostazol (Pletal®)
    • Ticlopidine (Ticlid®)
    • Dabigatran (Pradaxa®)
    • Prasugrel (Effient®)
    • Aspirin
      • If your doctor asks you to stop taking aspirin for the procedure, stop taking it 5 days before your procedure. If you have any questions, call Interventional Radiology. The number is (212) 639-2236. Ask to speak with the nurse.
  • Ask your doctor what to do if you take medicine for diabetes such as insulin, glucophage (Metformin®), or glipizide (Glucotrol®).
  • Vitamin E and non-steroidal anti-inflammatory medicines (NSAIDs) can also increase your risk of bleeding. You will need to stop taking medicines that contain vitamin E 10 days before your procedure. You will need to stop taking NSAIDS 2 days before your procedure. Examples of NSAIDs are ibuprofen (Advil®, Motrin®) and naproxen (Aleve®).

If you had a stroke or a heart attack, you may need to have another doctor's visit for medical clearance. This will be an important safety step for you.

  • Call your doctor develop any illness before your procedure. This includes a fever, cold, flu, or a sore throat.
  • Do not eat any solid food after midnight the night before the procedure.
  • Drink only clear liquids the day of your procedure.
    • Stop drinking liquids 2 hours before you are scheduled to arrive at the hospital for your procedure.
  • If you have any questions about the procedure, you may call an interventional radiology nurse between 9 a.m. and 5 p.m. The phone number is (212) 639-2236.

Pre-Procedure Telephone Call

The Admissions Center will call you the business day before your procedure. It is important that we have a phone number where we can reach you. It could be your home, office, hotel, or cell phone. If you give us your cell phone number, make sure the phone is charged and turned on. You will be told when to arrive for the procedure. We try to call between 3:00 pm and 7:00 pm. If you do not receive the call by 7:00 pm, please call (212) 639-7881.

Day of Procedure

  • On the day of the procedure, please be aware that many things can impact the start time of your procedure. The one before yours may last longer than expected. An emergency may need to be done in the room you are scheduled for. If there is a delay in your start time, we will let you know.
  • You must have a responsible adult go home with you after your procedure. We recommend that your care partner drive you home or take you in a taxi. An adult must also stay with you until the following morning.
  • You may shower, but do not apply any cream or lotion.
  • Take any medications that your doctor or nurse told you to take with water or another clear liquid.
    • Do not take medicines that thin the blood (see “Before Your Procedure”) unless your doctor told you to.
    • Do not take diuretics (medicines that make you urinate) such as furosemide (Lasix®) or hydrochlorothiazide (HCTZ).
  • Bring:
    • Your medicines with you on the day of the procedure.
    • Only the money you need (e.g., for a newspaper or parking costs).
  • If you use contact lenses, wear glasses instead. If you do not have glasses, bring a container for your contact lenses.
  • Leave valuables and jewelry, including rings, at home.

Enter the hospital through the main entrance at 1275 York Avenue. Take the M elevators at the top of the escalator to the 2nd floor. As you step off the elevator, enter the double doors to the Pre-Surgical Center (PSC). Check in at the desk. Please arrive on time.

In the PSC, you will change into a gown, robe, and slippers. An intravenous (IV) line will be started. When you are ready, you will be taken to Interventional Radiology.

Procedure

After you are positioned on the table, the radiologist will take images of the area to be biopsied. You will get medicine through your IV to help you relax. When the area has been located, the radiologist will mark it with ink on your skin.

The skin around the marked area will be cleaned and covered with a drape. You will get an injection to numb the site. The radiologist will then insert the biopsy needle and check its position with images. Try not to move at all. You may feel slight discomfort as the needle is inserted.

When the needle is in the right place, a sample of tissue will be taken. You may feel pulling or pinching as this is done. The sample will be checked to make sure there is enough tissue. If there is enough, the radiologist will then remove the needle. If there is not enough, another sample will be taken. When the procedure is finished, the site will be cleaned and covered with a Band-Aid® or other bandage.

Some patients cough up some blood right after the biopsy. This is expected. It generally does not last more than a few minutes.

Risk of Lung Collapse

After the biopsy, patients need careful monitoring. A biopsy of the lung, pleura, mediastinum, or adrenals can cause the lung to collapse. This can happen if air leaks out of the lung and collects around the lung. As the amount of air increases, it prevents the lung from expanding fully.

About 25 to 30 out of 100 patients develop some collapse of the lung. Most patients will not have symptoms and will get better without treatment. About 5 out of 100 patients will need treatment with a chest tube. The tube allows the air to escape until the leak heals itself. Your doctor will tell you about the chest tube if you need one.

After Your Procedure

You will have at least 2 chest x-rays after the biopsy. The first is done immediately. The second will be taken about 2 hours later. If your lung has collapsed, the doctor will decide whether you need more chest x-rays to watch the lung. The x-ray may indicate that a small chest tube needs to be placed to allow your lung to re-expand. It is possible that you will be admitted to the hospital to allow your lung to re-expand.

After your first chest x-ray, you will be taken by stretcher to the post anesthesia care unit (PACU). You will be observed there for 2 hours. Tell your nurse if you have:

  • Any shortness of breath or trouble breathing
  • Pain or discomfort
  • Any symptoms that concern you

During this time, you may be required to lay flat. You may be given oxygen through your nose. You may or may not be allowed to eat right after the procedure. This depends on the results of your first chest x-ray.

After 2 hours, you will have your second chest x-ray. If it is normal, you will be able to go home. You must go with your adult care partner.

Discharge Instructions

  • You must have a care partner stay with you until the next morning. This is for your safety if something should happen at night. If you do not have anyone to stay with you, please discuss options with your doctor.
  • If you become short of breath or have chest pain, call 911 or go to the closest emergency room. Tell the doctor what kind of biopsy you had.
  • Call the interventional radiologist immediately if you develop:
    • Increasing pain at biopsy site
    • Swelling at the biopsy site
  • You may resume your normal diet when you leave.
  • You can shower the next day. Change the Band-Aid® after your shower. Do not take a tub bath or soak in water for 24 hours.
  • You may resume all normal activities the day after the procedure.
  • The doctor who ordered the biopsy will contact you to tell you the results. Ask when you can expect to hear. Some biopsy results are ready in 48 hours, others take up to 7 days.
  • If you plan to travel by air, talk with your doctor first. After these types of biopsies there is a risk of lung collapse. See section “Risk of Lung Collapse” for a detailed discussion of this risk. If there is no lung collapse seen on chest x-ray, it is safe to fly 2 days after the procedure. If your chest x-ray shows a lung collapse, air travel will have to be delayed for your safety. This is true whether or not you need a chest tube. If you think you will be traveling within two weeks of the biopsy, please discuss your plans for any kind of travel with the radiologist who is doing the procedure at the time of consent.