Surgical biopsy for lung cancer

During a surgical biopsy for lung cancer, your surgeon takes a sample of the lung tissue by making small cuts in your chest.

The surgeon carries out your biopsy in one of the following ways:

• keyhole surgery , also called video assisted thoracoscopy surgery (VATS)
• open surgery, through a small cut in the chest wall (small thoracotomy)

You have this test under general anaesthetic . So, you will be asleep and won’t feel anything.

Why do I need a surgical biopsy?

A surgical biopsy of the lung can help diagnose lung cancer. You might have this test if:

• a CT scan has shown an abnormal area in your lung or airways
• the area is difficult to sample because of its position

What do I need to do to prepare for a surgical biopsy?

Most people will attend a pre assessment clinic 1 to 2 weeks before the test. During this visit, you will:

• have an assessment to check if you are fit enough to have a surgical biopsy
• have a blood test, any other tests you might need will be arranged
• see an anaesthetist who will assess you. They will tell you what to expect from the anaesthetic and how your pain will be managed afterwards

You’ll be given written instructions on how to prepare for your surgical biopsy. For example, they will ask you not to eat and drink for a few hours before the test.

Take your usual medicines as normal unless your doctor tells you otherwise. If you take warfarin or other blood thinners to thin your blood, you need to stop this before your test. Your doctor will tell you when to stop them.

What happens on the day?

Before the test

You might stay in hospital the night before your biopsy or go in on the morning of the test.

Your nurse will give you a hospital gown and anti embolism stockings. You wear these while you can’t move around as much as usual afterwards. These tight stockings squeeze your feet and legs, helping the blood circulate better. Your nurse will help you put them on if you can’t manage it.

Your team will ask you to have a shower or a bath the night before your operation. During your pre assessment appointment, they might give you a special antiseptic cleaning soap to use. You have to shower or bathe again on the morning of your surgery using the same soap.

Before you go to the operating theatre, your surgeon will mark an area on your skin where you will have the operation using a special marker pen. They will explain the procedure to you. Ensure you understand what will happen during the procedure before signing the consent form.

Your nurse may give you a tablet to help you relax before you go to the operating theatre.

Having a general anaesthetic

Your nurse takes you to the operating theatre. They put a small tube into a vein in the back of your hand. Your anaesthetist gives you the anaesthetic medicine through the tube.

Once you are asleep, you are turned on your side with your arm above your head.

During video assisted thoracoscopy surgery (VATS)

Your surgeon makes one or more small cuts in your chest. Each cut measures between 1cm to 5cm.

The number of cuts and the position depend on:

• the type of surgical biopsy you have
• which part of the lung the surgeon needs to take the biopsy from

Your surgeon will use a small flexible camera to look at parts of your lung. They take out a small piece of the abnormal area to examine under a microscope. A pathologist then looks at the cells through a microscope to find out exactly what the abnormality is.

During an open lung biopsy

An open lung biopsy is not used very often to diagnose lung cancer. Your surgeon makes a cut (incision), usually in the side of your chest. The size of the cut depends on where the abnormal cells are. This might vary between a few centimetres up to 30 cm long.

The surgeon uses stitches underneath the skin to close your wound. They put in a tube close to the wound (a chest drain) to drain any extra fluid or air.

After your biopsy

You usually stay in hospital for at least 3 days. Or you might need a bit longer to recover than this.

When you wake up, you have several different tubes in place. This may make you feel a little anxious. But it helps to know what they are all for.

You might have some, but not all of the following:

• a drip (intravenous infusion) – so you can have fluids into a vein until you are eating and drinking normally again
• a patient controlled analgesia (PCA) drip – you have a painkiller into a tube in your vein and a button to press to give a higher dose of the painkiller if you need it
• a fine tube into your back that gives a continuous infusion of a local anaesthetic to the nerves in the area
• a chest drain – this helps to drain air and fluid from around the biopsy area. You normally have it for between 24 to 48 72 hours
• a catheter (tube into your bladder) – this drains your urine until you are moving around again
• an oxygen mask or little tubes into your nostrils with oxygen. You might need it for a short time after your biopsy

Eating and drinking

You will be able to eat and drink again as soon as your doctor thinks it’s safe. You might have less appetite than normal. But you will have plenty of fluids through your drip. Your nurse can give you anti sickness medicines if you feel sick.

Moving around

You gradually start sitting up and moving around. Your nurse will help you at first but you should get more independent over a couple of days.

Breathing exercises

Your physiotherapist and nurse will show you breathing exercises to do. These help to prevent chest infections and help you recover more quickly.

Pain control

Your doctor will change your painkiller drip (PCA) or local anaesthetic infusion to tablets or liquid medicines after a while. Then you can move around more easily.  

Let your nurse know if your pain isn’t under control. You might find you need a painkiller top up sometimes before moving or doing your breathing exercises.

Going home

Your doctor will let you know when they think you are ready to go home. Everyone takes a different amount of time to recover from a surgical biopsy.

Medicines

Take any medicines you have been prescribed exactly as your doctor or pharmacist told you. Your pharmacist can make you a reminder sheet if it would help you.

Take your painkillers regularly. Speak to your GP or hospital doctor if they aren’t working. They can do a lot to help, like changing the dose or type of medicine.

Breathing exercises

Keep doing the breathing exercises you were taught. This helps your recovery.

Wounds and dressings

Your nurse will show you how to look after your wounds and the drain area. You might need to go to your GP so they can replace the dressings.

Resting

It is normal to feel very tired after a surgical biopsy. Take things easy and plan rest times in between activities.

Possible risks

The possible risks include:

Coughing up blood

You might cough up a little blood for a few days. Doing your breathing exercises helps to clear this. If it’s a lot of blood let your doctor or nurse know straight away.

Bleeding

It is normal to have blood draining into your chest drain bag. Once your chest drain is out, let your doctor or nurse know straight away if your wounds bleed a lot.

Chest infection

See your doctor immediately if your phlegm (sputum) changes colour, you start feeling more breathless, or you feel like you have a temperature. Moving around and doing your breathing exercises helps to prevent a chest infection.

Wound infection

Let your doctor or nurse know if your wound feels hot or is oozing a lot. If you get a wound infection you will have antibiotics.

Needing extra oxygen

You might need oxygen through a mask for some time after your biopsy. If you normally have oxygen at home, you might need to have more than usual for a while.

Pain

It is quite common to have some pain after a surgical biopsy of the lung. Let your doctor or nurse know if it is not controlled so they can help you. 

Shoulder pain

It is quite common to have shoulder pain after this procedure. Take painkillers if you need to and move your shoulder regularly. 

A collapsed lung (pneumothorax)

Air or gas can collect in the space around the lung and make it collapse but this is rare. Contact a doctor if you get short of breath or have chest pain. You have a tube put into the lung to remove the air.

Let your doctor know if you are due to fly soon after your biopsy. They can tell you how long to wait before taking a flight.

Blood clots

Surgery increases the risk of getting a blood clot. Blood clots can be life threatening. You will have a daily injection to thin your blood to reduce this risk. You will also wear compression stockings to improve circulation in your legs. It is important to try and move as much as possible and to drink plenty of fluids.

Getting your results

You should get your results within 1 or 2 weeks. Contact your doctor if you haven’t heard anything after this time.

Waiting for test results or for further tests can be very worrying. You might have contact details for a specialist nurse and you can contact them for information if you need to. It may help to talk to a close friend or relative about how you feel.

More information

You can read more information about other tests to help doctors diagnose lung cancer.