What is a Bronchoscopy with Transbronchial Biopsy?
Brochoscopy is a simple medical procedure. It is used to see inside the lungs. Bronchoscopy can be combined with a procedure to collect pieces of lung tissue. This is called a transbronchial lung biopsy.
A lung biopsy allows a doctor to test for many kinds of diseases, including:
- benign tumors
There are two main ways to perform a bronchoscopy:
A rigid bronchoscope is often used when a foreign object is lodged in the throat or lungs. It can also be used when there is excessive bleeding inside the lungs. The rigid scope’s wider circumference makes it easier to perform treatments or remove foreign objects. Rigid bronchoscopy requires the patient to be completely asleep under general anesthesia. It can be used to perform a biopsy. However, it is unlikely to be used unless you also need another procedure.
A fiber-optic or flexible bronchoscope is more often used for lung biopsy. This device is a soft, flexible tube that is small in circumference. It is less than 1/2 inch wide and approximately two feet long. The tube contains a high-beam light and a video camera. It can be easily steered through the lungs.
Other names for performing a biopsy during a bronchoscopy include:
- bronchoscopy with lung biopsy
- fiber-optic bronchoscopy with lung biopsy
How a Biopsy is Performed
Fiber-optic scopes are hollow. This allows your doctor to insert other instruments through the scope. These might include a lavage device to irrigate your throat or forceps (surgical scissors) for when cutting is needed.
Outpatient bronchoscopy is usually well-tolerated. It is performed under moderate sedation by a pulmonologist (respiratory specialist) trained in bronchoscopy. You will be awake the whole time.
The procedure is usually done in a surgery room or intensive care unit. These places are equipped to manage respiratory emergencies. If there is a problem during or after the procedure, you may require a hospital stay. Problems requiring a hospital stay include:
- excessive bleeding
- respiratory distress
- pneumothorax (leaking of air from the lungs)
Bronchoscopy with transbronchial biopsy usually takes a couple of hours or less. It involves the following steps:
- A local anesthetic will be sprayed to numb your throat.
- Before the numbing agents take effect, you may feel fluid running down your throat. This may cause you to cough or gag.
- If you cough during the procedure, more anesthetic will be given.
- You may be given an intravenous (IV) sedative to help you relax.
- When the area is numb, the flexible bronchoscope will be threaded through the trachea (windpipe) into your lungs. The tube may be inserted through either your nose or mouth. Numbing gel will be inserted into your nose, if needed.
- You might feel short of breath when the tube is in your throat. There is no risk of suffocation.
- The doctor will use the light and camera to find the area in your lungs to biopsy.
- Real-time fluoroscopy (X-ray imaging) may also be used steer the scope.
- Tiny forceps will be used to take small samples of lung tissue. You may need to breathe out slowly while the samples are taken.
- Saline (salt water) may be used to flush the area and collect lung secretions.
You will be carefully monitored throughout the procedure and recovery. Immediately after the procedure, you may receive an X-ray or CT (computed tomography) scan. This will rule out pneumothorax (leaking of air from the lungs).
You will need to wait until the numbness wears off (one to two hours) before eating or drinking.
If you try to eat or drink too soon, there is a severe risk of choking.
Preparing for the Procedure
Do not eat or drink anything for six to 12 hours before your test. Your doctor may also ask you to avoid certain medications that thin your blood. They can increase the risk of bleeding during or after the test.
Medications that can thin the blood include:
- blood thinners (Warfarin, Coumadin, Jantoven, Marfarin)
- nonsteroidal anti-inflammatory drugs (Motrin, Advil, Aleve)
Be sure to talk with your doctor before starting or stopping any medication.. If needed for pain, your doctor may approve taking acetaminophen (Tylenol).
Make arrangements for someone to take you to the hospital and home. You should also arrange to take time off from your usual activities. You will need to rest after the procedure.
Following Up After the Procedure
After the procedure, you should test your gag reflex before eating or drinking anything. Place a spoon gently onto the back of the tongue. This should cause you to gag. If it doesn’t, try again every few minutes. Do not eat or drink until your gag reflex returns.
In the week following the procedure, you may have:
- a cough
- a sore, scratchy throat
Ideally, you should rest quietly for one or two days after your bronchoscopy.
Call your doctor right away if you:
- develop a fever over 100 degrees F
- have chest pain
- cough up more than 2 to 3 tablespoons of blood
- have difficulty breathing
It is normal to cough up blood-tinged (pink) sputum for a few days.
Risks of Bronchoscopy
Although the procedure carries some risks, they are low. This test provides important diagnostic information. It may help you avoid a much riskier, major surgery.
Complications of bronchoscopy are extremely rare. However, risks include:
- allergic reactions to sedatives
- damage to the vocal cords
- tearing in the lung
- bronchial spasms
- irregular heart rhythms
Risks of biopsy, which are also rare, include:
- pneumothorax (leaking of air from the lungs)
- excessive bleeding at the biopsy site
- heart attack (extremely rare)
- arrhythmia (irregular heartbeat/extremely rare)
- hypoxemia (low blood oxygen/extremely rare)
Why the Test is Ordered
There are several reasons you might need a bronchoscopy with transbronchial biopsy. The most common reasons are:
- lung changes seen on an X-ray or imaging test
- suspected interstitial lung disease (shortness of breath)
- signs of lung transplant rejection
- coughing up blood
- unexplained cough lasting more than three months
- chronic lung or bronchial infections
What Your Test Results Mean
Normal test results mean your lungs are healthy. There are no problems with your bronchial tubes and alveoli (air sacs). You have clear, infection-free secretions.
Abnormal results can be caused by a number of different problems, including:
- adenoma (tumor)
- alveolar abnormalities
- bronchial abnormalities
- endobronchial mass
- anaerobic bacterial infections
- CMV pneumonia
- fungus infections
- histoplasmosis infections
- Pneumocystis carinii pneumonia (PCP)
- tuberculosis or mycobacterial infection
- allergy-related lung inflammation (hypersensitivity pneumonitis)
- rheumatoid lung disease