What is a bronchoscopy with transbronchial biopsy?
Bronchoscopy is a diagnostic medical procedure. Your doctor can use it to see inside the airways of your lungs. Bronchoscopy can be combined with a transbronchial lung biopsy, which is a procedure used to collect pieces of lung tissue.
A lung biopsy allows your doctor to test for many kinds of diseases, including infections, benign tumors and polyps, and cancer. They can also use a lung biopsy to assess the stage of a known malignancy.
A biopsy performed during a bronchoscopy is also called a bronchoscopy with a lung biopsy or a fiber-optic bronchoscopy with a lung biopsy.
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 CT scan or other imaging test
- a tumor
- suspected interstitial lung disease, which can cause shortness of breath
- a suspected lung transplant rejection
- coughing up blood, or hemoptysis
- an unexplained cough lasting more than three months
- chronic lung or bronchial infections
How a biopsy is performed
Outpatient bronchoscopy is usually well-tolerated. It’s typically performed under moderate sedation by a pulmonologist, or lung specialist, trained in bronchoscopy. You’ll 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’s a problem during or after your procedure, you may require a hospital stay. Problems requiring a hospital stay include:
- excessive bleeding
- respiratory distress
- pneumothorax, or a collapsed lung
Bronchoscopy with transbronchial biopsy usually takes a couple of hours or less.
To start, a local anesthetic is sprayed on your throat to numb it. Before the numbing agents take effect, you may feel fluid running down your throat. This could cause you to cough or gag. If you cough during the procedure, more anesthetic will be given. You may also be given an intravenous (IV) sedative to help you relax.
When your throat is numb, a flexible bronchoscope is threaded through your trachea, or windpipe, into your airways. The tube may be inserted through either your nose or mouth. Numbing gel will be applied inside your nose, if needed. You might feel short of breath when the tube is in your throat, but there’s no risk of suffocation.
There are two main types of bronchoscopes used to perform a bronchoscopy:
A rigid bronchoscope is often used when a foreign object is lodged in the throat or airways. It can also be used when there’s excessive bleeding inside the lungs. The rigid scope’s wider circumference makes it easier to perform treatments or remove foreign objects.
Rigid bronchoscopy requires you to be completely asleep under general anesthesia. It can be used to perform a biopsy. However, your doctor probably won’t use rigid bronchoscopy 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’s small in circumference. It’s less than 1/2-inch wide and approximately 2 feet long. The tube contains a high-beam light and a video camera. It can be easily steered through your lungs.
Fiber-optic scopes are hollow. This allows your doctor to insert other instruments through the scope. These might include a device for irrigating your throat or forceps, which are surgical scissors, for cutting if needed.
Your doctor uses a light and camera to find the area in your lungs to biopsy. Real-time fluoroscopy, or X-ray imaging, may also be used steer the scope. Your doctor collects small samples of your lung tissue with tiny forceps. You may need to breathe out slowly while the samples are being taken. Saline, or salt water, may be used to flush the area and collect lung secretions.
You’ll be carefully monitored throughout your procedure and recovery. Immediately after the procedure, you may receive an X-ray. This can help your doctor rule out a pneumothorax, which is the leaking of air from your lungs.
You’ll need to wait until the numbness wears off, which takes one to two hours, before eating or drinking. If you try to eat or drink too soon, you’ll have a severe risk of choking.
Preparing for the procedure
Don’t eat or drink anything for 6 to 12 hours before your test. Your doctor may also ask you to avoid certain medications that thin your blood. They can increase your risk of bleeding during or after your test.
Some of the medications that can thin the blood include:
- aspirin (Bufferin)
- blood thinners, such as warfarin (Coumadin, Jantoven)
- nonsteroidal anti-inflammatory drugs, such as ibuprofen (Motrin, Advil) or naproxen (Aleve)
Be sure to talk to your doctor before starting or stopping any medication. If you need it for pain, your doctor may approve 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’ll 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 your tongue. This should cause you to gag. If it doesn’t, try again every few minutes. Don’t eat or drink until your gag reflex returns.
In the week following the procedure, you may have a:
- hoarse voice
- 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°F
- have chest pain
- cough up more than 2 to 3 tablespoons of blood
- have difficulty breathing
It’s normal to cough up blood-tinged, or pink, sputum for a few days.
Risks of bronchoscopy
Although the procedure carries some risks, they’re low. This test provides important diagnostic information. It may help you avoid major surgery, which is much riskier.
Complications of bronchoscopy are extremely rare. However, they include:
- an allergic reaction to sedatives
- an infection
- damage to your vocal cords
- tearing in your lung
- bronchial spasms
- irregular heart rhythms
The risks of a biopsy, which are also rare, include:
- a pneumothorax, or leaking of air from your lungs
- excessive bleeding from your biopsy site
- a heart attack, which is extremely rare
- arrhythmia, or an irregular heartbeat, which is extremely rare
- hypoxemia, or low blood oxygen, which is extremely rare
What your test results mean
Normal test results mean that your lungs are healthy and there are no problems with your bronchial tubes or alveoli, which are air sacs. Normal results also mean you have clear secretions that are free of infection.
Abnormal results can be caused by a number of different problems, including:
- an adenoma, which is a benign tumor
- alveolar abnormalities
- bronchial abnormalities
- endobronchial masses
- bacterial infections
- Cytomegalovirus (CMV) pneumonia
- Pneumocystis carinii pneumonia (PCP)
- fungal infections
- histoplasmosis infections
- mycobacterial infection
- allergy-related lung inflammation, or hypersensitivity pneumonitis
- rheumatoid lung disease
Your doctor will discuss test results with you and recommend next steps if you need treatment.