This test is done for finding the exact type of lung cancer. Biopsies are the process of taking small amount of cells from tumor and examine them under microscope. Follow are the several ways to take a sample from tumor:
- Bronchoscopy and Biopsy:
In this process first doctor sprayed a numbing medicine at patient’s mouth and throat, also give medicine through an intravenous (IV) line to make patient feel relaxed. Once patient feel relax doctor insert a bronchoscope called tube through down the throat and through your windpipe and bronchi to look at the lining of the lung’s main windpipe. Bronchoscope is a long, thin, flexible, fiber-optic tube made especially for this test.
Once the tumor found doctor take small sample of the tumor from patient windpipe called biopsies through the tube. To taking sample from windpipes lining doctor will do bronchial brushing and bronchial washing. In bronchial brushing doctor take a small sample by wiping a tiny brush over the surface of the tumor and in bronchial washing doctor rinse the windpipes with sterile saltwater and then collecting it. These samples are then tested under microscope.
In this Biopsy you cannot easily diagnose that tumor is Lung Carcinoid Tumor, but sometimes it helpful in additions to the bronchial biopsy. The main advantage of this biopsy is that you do not need to admit in hospital, you can go home with in hour.
- Endobronchial Ultrasonography (EBUS) and Biopsy:
This test is performed to test that enlarged lymph nodes on either side of the trachea or in the area just below where the trachea divides found in CT scan are they tumor.
To perform this test doctor numbing the patient with numbing medicine and insert a microphone-like instrument called a transducer in which bronchoscope is fitted down to windpipe. This transducer generates black & white image over computer to give the picture of organs to doctor. This process is called endobronchial ultrasound.
The transducer looks at lymph nodes and around the mediastinum – area between the lungs. Then a hollow needle is inserted through bronchoscope to get biopsy samples of enlarged lymph nodes or other abnormal areas. These samples are then tested under microscope.
- Needle Biopsies:
Hollow needle is used to take sample from infected area. There are two kind of needle biopsies based on needle used:
I. Fine Needle Aspiration (FNA) Biopsy:
In this doctor uses a syringe with a very thin, hollow needle to take a sample from infected area.
II. Core Biopsy:
In this doctor a larger needle to take a sample from infected area.
Other than needle type the main difference between FNA biopsy and core biopsy is the core biopsy takes large sample then FNA biopsy.
Main advantage of this test is that there is no cut in patient’s body, means no surgery and he can go home within an hour or so. But sometimes sample taken by needle biopsy is not enough to take proper decision and then surgical biopsies needed.
- Surgical Biopsies:
Sometime sample taken from above biopsy is not enough to take proper decision then surgical biopsy is done. There are three kind of surgical biopsies, as follow:
In Thoracotomy surgery doctor makes a cut in the chest wall between the ribs to get to the lungs and to the space between the lungs and the chest wall. Sometime this surgery done to remove the entire tumor, if doctor strongly suspects a carcinoid or some other type of lung cancer is this tumor, without doing the biopsy.
In Thoracoscopy surgical biopsy doctor make a cut to get into the lungs and the chest wall, but this cut is not as long as Thoracotomy. Through this cut doctor insert a thin, lighted scope with a small video camera and get the sample of infected area. Sometime need to get two cut in this surgery. This test also done to take a sample of lymph nodes and fluid, also to check that tumor is not spreading to nearby tissues or organs.
Mediastinoscopy is only done if imaging test shows that tumor spreading to the lymph nodes in the mediastinum. In this test a small cut is made in front of the neck and a thin, hollow, lighted tube is inserted in-between the breast bone and windpipe to look at the area. Instruments can be passed through this tube to take tissue samples from the lymph nodes along the windpipe and the bronchi.