Doru Paul, MD, is triple board-certified in medical oncology, hematology, and internal medicine. He is an associate professor of clinical medicine at Weill Cornell Medical College and attending physician in the Department of Hematology and Oncology at the New York Presbyterian Weill Cornell Medical Center.

A lung biopsy is a procedure to get a sample of suspicious lung tissue. By looking at the sample under the microscope, healthcare providers can better determine what exactly is causing an abnormality—and whether it is due to cancer or not.

A lung biopsy is also needed to determine the type of lung cancer, if present, as well as the molecular or genetic profile of the tumor.

There are several reasons a lung biopsy may be recommended:

In a fine needle lung biopsy, healthcare providers place a long needle through your back and into your lung to get a sample of tissue. This is done with the use of a CT scanner or ultrasound to help guide the needle to the appropriate location.

A needle biopsy is the least invasive way to sample a suspicious region in your lungs, but it does not always get enough tissue to adequately make a diagnosis. A needle lung biopsy is also called a transthoracic biopsy or a percutaneous biopsy.

A transbronchial biopsy is done during a bronchoscopy, a procedure in which a scope is directed down from your mouth and into the upper airways of your lungs.

With the help of an ultrasound (endobronchial ultrasound), physicians can then direct a needle into a suspicious area and obtain a sample (transbronchial needle aspiration.)

This procedure is most effective when an abnormality or tumor is located in or near the large airways of the lungs.

In a thoracoscopic lung biopsy, a scope is introduced through the chest wall and into the region of the lung to be biopsied. A video camera is used to help healthcare providers find and biopsy the area of tissue.

In this procedure, also known as video-assisted thoracoscopic surgery (VATS), practitioners may also be able to remove an area of suspicious tissue or a lobe of the lung that is cancerous. (If this is planned, it will be discussed with you before the procedure.)

As the most invasive way to sample tissue, an open lung biopsy is sometimes necessary to sample tissue when other methods have failed.

This is a major surgical procedure, done under general anesthesia. It may require separating the ribs or removing a portion of a rib to gain access to the lungs.

Sometimes, an open biopsy is performed as part of surgery to remove a nodule or mass, especially if your surgeon is quite certain that you have cancer.

A liquid biopsy is an exciting new area being studied to evaluate lung cancer. This procedure, requiring a simple blood draw, looks for circulating cancer cells in order to evaluate tumor DNA for driver gene mutations.

Sometimes when a lung biopsy is done, physicians are unable to extract enough tissue to perform this testing, and a liquid biopsy could make these results available without having to go after more tumor tissue.

The first liquid biopsy for detecting EGFR mutations in people with non-small cell lung cancer was approved in June 2016. In general, though, a tissue biopsy is still preferred in the majority of cases.

If your healthcare provider is able to get a good sample of tissue, you will likely hear about the results within two to three days. This may take longer, though, especially if more than one pathologist wishes to review the results.

It is helpful to ask your practitioner when and how you can expect to get your results. Some may require you to make a follow-up appointment so your results can be reviewed in person, while others may be comfortable calling you about the findings.

Though your healthcare provider may have a good idea of what the results will be, it’s not uncommon for physicians to be wrong after seeing a sample of tissue. The likelihood of an abnormality being cancerous depends on many factors, one of which is the size.

Lung nodules (spots on the lung that are 3 centimeters [1½ inches] or less) are less likely to be malignant than lung masses (spots on the lung that are greater than 3 centimeters in size).

On occasion, a report may deem a biopsy "inconclusive." This means that the sample of tissue did not reveal a diagnosis. If that is the case, there are still several options.

It's important to note that everyone with non-small cell lung cancer should have gene testing (molecular profiling) done on their tumor. Raise this to your healthcare provider if it has not yet been discussed.

Currently, medications are approved for those with ALK rearrangements, EGFR mutations, ROS1 rearrangements, and other less common genetic alterations. Treatments for other targetable mutations are being done in clinical trials.

Needle biopsies are considered a very safe way to take a biopsy of the lungs when needed. Still, there are risks to be aware of.

The risks of a lung biopsy vary depending on the type of procedure, the location of the tissue, and your general health.

The most common complications are bleeding or an air leak from your lung. Other possible complications include:

Whatever the reason your healthcare provider has recommended a lung biopsy, waiting for the results can be difficult—but so too can foregoing the test and living in a state of never knowing.

Lean on your loved ones for support. If your mind goes to the worst-case scenarios, keep in mind that medicine is always changing. There were more new treatments approved for the treatment of lung cancer between 2011 and 2016 than during the 40 years preceding 2011.

National Institute of Health. Lung needle biopsy.

Dietel, M. et al. Diagnostic procedures for non-small-cell lung cancer (NSCLS): recommendations of the European Expert Group. Thorax. 2015 Nov 3. (Epub ahead of print) doi:10.1136/thoraxjnl-2014-206677

Yao, X. et al. Fine-needle aspiration biopsy versus core-needle biopsy in diagnosing lung cancer: a systematic review. Current Oncology. 2011. 19(1):e16-27. doi:10.3747/co.19.871

National Institute of Health. Open Lung Biopsy.

Zhang, A., Ramnath, N., and S. Nagrath. Current Status of CTC’s as Liquid Biopsy in Lung Cancer and Future Directions. Frontiers in Oncology. 2015. 5:209. doi:10.3389/fonc.2015.00209

Jiang, T., Ren, S., and C. Zhou. The role of circulating-tumor DNA analysis in non-small cell lung cancer. Lung Cancer. 2015. 90(2):128-34. doi:10.1016/j.lungcan.2015.09.013

Wu, C. et al. Complications of CT-guided percutaneous needle biopsy of the chest: prevention and management. AJR: American Journal of Roentgenology. 2011. 196(6):W678-82. doi:10.2214/AJR.10.4659

Freund, M. et al. Systemic air embolism during percutaneous core needle biopsy of the lung: frequency and risk factors. BMC Pulmonary Medicine. 2012 Feb 6. (Epub ahead of print) doi:10.1186/1471-2466-12-2

Hare, S. et al. Systemic arterial air embolism after percutaneous lung biopsy. Clinical Radiology. 2011. 66(7):589-96. doi:10.1016/j.crad.2011.03.005

Robertson, E., and G. Baxter. Tumour seeding following percutaneous needle biopsy: the real story! Clinical Radiology. 2011. 66(11):1007-14. doi:10.1016/j.crad.2011.05.012

By Lynne Eldridge, MD  Lynne Eldrige, MD, is a lung cancer physician, patient advocate, and award-winning author of "Avoiding Cancer One Day at a Time."

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