Patient Education - Lung Cancer Program at UCLA
yourself about lung cancer:
with transbronchial biopsy
Bronchoscopy with transbronchial biopsy is a procedure in which a bronchoscope is inserted
through the nose or mouth to collect several pieces of lung tissue.
Biopsy - lung - bronchoscopic
How the Test is Performed
A lung specialist (pulmonologist) trained to perform a bronchoscopy sprays a topical
or local anesthetic in your mouth and throat. This will cause coughing at first, which will
cease as the anesthetic begins to work. When the area feels "thick," it is sufficiently
You may be given an intravenous (IV) sedative to help you relax. This medication may make
you sleepy and should reduce any anxiety you might have about the procedure. The procedure
can also sometimes be performed using general anesthesia, during which you are unconscious
If the bronchoscopy is performed via the nose, an anesthetic jelly will be inserted into
one nostril. When the nostril is numb, the scope will be inserted through the nostril until
it passes through the throat into the trachea and bronchi. Usually, a flexible bronchoscope
is used. This tool is a tube that is less than 1/2 inch wide and about 2 feet long.
As the bronchoscope is used to examine the airways of your lungs, samples of your lung
secretions may be obtained to send for laboratory analysis. Saline fluid may be used to flush
the area and to collect cells that may need to be analyzed by a pathologist.
The transbronchial biopsy procedure is performed using a tiny forceps passed through a
channel of the bronchoscope into your lungs. You will be instructed to breathe out slowly
as the pulmonologist obtains a small sample of lung tissue. This step is usually repeated
until several samples of tissue have been obtained for analysis. Occasionally real-time chest
x-rays (fluoroscopy) are used during the bronchoscopy to help direct the forceps to the desired
area of lung.
How to Prepare for the Test
This test may require an overnight stay in the hospital. You must sign an informed consent
You should not eat for 6 to 12 hours before the test. You may be told to avoid aspirin,
nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, or blood thinniners such
as warfarin for a period of time before the procedure. Always check with your health care
provider before changing or discontinuing any medications.
Arrange for transportation to and from the hospital. Many people want to rest the following
day, so make arrangements for work, child care, or other obligations.
How the Test Will Feel
Local anesthesia is used to relax your throat muscles. You may feel fluid running down
the back of the throat, and feel you need to cough or gag until the anesthetic takes effect.
Despite the anesthesia, you may have sensations of pressure or mild tugging as the tube
moves through the trachea. Many patients experience a feeling of suffocation when the tube
is in the throat, but there is no risk of suffocation. Try to remain calm. If you cough during
the test, more anesthetic will be added.
An x-ray is often taken after the bronchoscope is removed. When the anesthetic wears off,
your throat may be scratchy for several days. After the test, your cough reflex will return
in 1 to 2 hours, then normal eating and drinking is allowed.
It is common after a transbronchial biopsy to cough up small amounts of blood-tinged sputum
for a day. The pulmonologist will give you instructions on whom to contact should you cough
up significant amounts of blood.
Why the Test is Performed
A transbronchial biopsy is most often performed when there is diffuse infiltrative pulmonary
disease, tumors, rejection of a transplanted lung, or severe illness that prevents the use
of open lung biopsy.
The trachea and bronchi normally appear pink and smooth and have minimal secretions and
no foreign bodies, growths, obstructions, or infections. The sample obtained with a transbronchial
biopsy should be normal tissue from the lining of the bronchus and air sacs (alveoli).
What Abnormal Results Mean
- Bronchial abnormalities, tumors
- Endobronchial mass
- Adenoma (tumor)
- Infection such as:
- Fungus infections
- Histoplasmosis infections
- Anaerobic bacterial infections
- Tuberculosis or mycobacteria
- CMV pneumonia
- PCP (Pneumocystis carinii pneumonia)
- Hypersensitivity pneumonitis (inflammation of the lungs related to allergy-type reactions)
- Rheumatoid lung disease
- Alveolar abnormalities such as alveolar proteinosis
- Non-necrotizing granulomatous inflammation
- Necrotizing granuloma (granular tumor)
- Caseating granulomas
- Peribronchial granulomas
Pneumothorax occurs in about 2% of transbronchial biopsies. Usually this is followed
with repeated chest x-rays unless the pneumothorax is large enough to require insertion of
a chest tube to decompress the lung.
Whenever a biopsy is taken, there is a risk of hemorrhage. Some bleeding is common, and
a technician or a nurse will monitor the amount of bleeding.
Lung infection may occur after any bronchoscopy.
There is also a small risk of:
- Disordered heart rhythm (arrhythmias)
- Heart attack
- Low blood oxygen (hypoxemia)
If general anesthesia is used, there is also some risk of:
- Nausea and vomiting
- Sore throat
- Muscle pain
- Breathing difficulties
- Depressed heart rate
- Change in blood pressure
- Kidney damage
There is a significant risk of choking if anything (including water) is ingested before
the anesthetic wears off.
To test whether your gag reflex has returned, place a spoon on the back of your tongue
for a few seconds with light pressure. If you do not gag, wait 15 minutes and try again.
Do not use small or sharp objects to test your gag reflex. Call your health care provider
or go to an emergency room immediately if you have shortness of breath or chest pain after
Review Date: 8/7/2006
Reviewed By: David A. Kaufman, M.D., Assistant Professor, Division of Pulmonary, Critical
Care & Sleep Medicine, Mount Sinai School of Medicine, New York, NY. Review provided
by VeriMed Healthcare Network.
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