Non-Small Cell Lung Cancer - Diagnostic Tests

Biopsy Procedures

Biopsies of lung tissue are needed confirm lung cancer. This requires invasive procedures that may vary from simple needle aspiration to chest surgery.

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Needle Aspiration. Sometimes, a biopsy specimen is obtained by inserting a needle between the ribs, and then guiding it with the use of computed tomography scans, ultrasound, or fluoroscopy (a device allowing an X-ray view). Specific techniques include transbronchial or transthoracic needle aspiration (TBNA or TTNA) or endoscopic ultrasound-guided needle aspiration (EUS-NA). Their use depends on how much of the area can be observed with less invasive imaging techniques. There is a 5% to 10% risk for bleeding or collapsed lung with this technique.

Thoracoscopy. Thoracoscopy is usually very effective for diagnosing peripheral cancer or those involving the pleura (membrane surrounding the lungs). This is a surgical procedure that uses a fiber-optic tube to view the area:

The procedure requires general anesthesia.
Small incisions are made in the chest, through which the surgeon passes surgical instruments and a fiber-optic tube with a camera to allow visualization of the lungs on a video screen.

Bronchoscopy. To locate cancer that develops in the central areas and major airways of the lung, usually squamous or small cell cancer, bronchoscopy is typically performed. The procedure is as follows:

The patient is given a local anesthetic, supplementary oxygen, and sedatives.
The doctor inserts a bronchoscope, a hollow flexible tube often containing a fiber-optic light source, into the lower respiratory tract through the nose or mouth.
The tube acts like a telescope into the body, allowing the physician to view the wind pipe and major airways. (In a procedure called fluorescence bronchoscopy, the patient is injected with a drug that makes cancer tissue appear red when exposed to laser light from the bronchoscope.)
The surgeon removes specimens for biopsy, ideally using a combination of techniques that include cutting tissue, using brushings, and using a washing process called bronchoalveolar lavage (BAL). BAL involves injecting saline through the bronchoscope into the lung and then immediately suctioning the fluid back through the hollow tube of the bronchoscope; the fluid is then analyzed in the laboratory. (Both brushing and washing procedures may be very valuable additions.)

Advances in this procedure, such as laser-induced fluorescence endoscopic bronchoscopy, may improve early detection of cancer.

Bronchoscopy is usually very safe, but complications can occur; they include allergic reactions to the sedatives or anesthetics, asthma attacks in susceptible patients, and bleeding. Fever may follow the procedure.