• Reference Number: HEY1066/2022
• Departments: Radiology
• Last Updated: 1 November 2022

Introduction

This leaflet has been produced to give you general information. Most of your questions should be answered by this leaflet. It is not intended to replace the discussion between you and the healthcare team, but may act as a starting point for discussion. If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team.

What is a CT Percutaneous Lung Biopsy

This is a minimally invasive way of obtaining a tiny piece of tissue from your lung using a special needle placed into the lung under CT guidance.  This is performed under local anaesthetic, i.e. you are awake but the skin is numbed. The tissues will be sent to a pathologist for examination under a microscope. You will normally go home the same day unless you do not have someone to watch over you for 24 hours following the biopsy, in which case a one night stay in hospital may be necessary.

Why do I need a percutaneous lung biopsy?

Other tests that you probably have had performed, such as a CT scan, will have shown that there is an area of abnormal tissue inside your body.  From the scan, it is not always possible to say exactly what the abnormality is due to, and the simplest way of finding out is by taking a tiny piece of it away for a pathologist to examine.

Who has made this decision?

The Consultant in charge of your case, and the Radiologist doing the biopsy will have discussed the situation, and feel this is the best way to diagnose your lung problem.  You will also have the opportunity for your opinion to be considered, and if, after discussion with your doctors, you do not want the procedure carried out, then you can decide against it.

Who will be performing the percutaneous lung biopsy?

A specially trained doctor called a Radiologist.  Radiologists have special expertise in using x-ray and CT scanning equipment, and also in interpreting the images produced.  They need to look at these images while carrying out the biopsy.

How do I prepare for the percutaneous lung biopsy?

You may need to attend your doctor / hospital for blood tests prior to the procedure to check that you do not have an increased risk of bleeding. We will inform you if this is required.

If you are taking any medication that can thin the blood could you please contact (01482) 622043 for further instructions.

If you are taking any other medication please take this as normal.

Please do not eat or drink anything after 7.00am on the day of your procedure.  Before 7.00am you may have a light breakfast e.g. tea and toast.

You may receive a call from one of the Radiology nurses prior to your procedure to discuss your healthcare needs.

If you have any allergies, you must let your doctor know.  If you have previously reacted to the dye used for kidney x-rays or CT scanning, then you must also tell your doctor about this.

What will happen during the procedure?

You will be introduced to every member of the team who will be involved in your care during the examination.

The doctor will discuss how the biopsy will be done, the risks involved and ask you to sign a consent form.

This confirms that you have:

• Understood the reason for the biopsy and how it will be performed.
• Understood the risks involved and any other procedures which may be needed.
• Agreed to have it performed.

You will be asked to change into a hospital gown.  Once inside the CT scanning room you will asked to lie on the scanning table, in the position that the radiologist has decided is more suitable.  You may need to have a needle put into a vein in your arm, so that the radiologist can give you an x-ray dye (a clear liquid used to highlight organs and blood vessels).

The radiologist will keep everything as sterile as possible. Your skin will be cleaned with antiseptic, and you will have some of your body covered with a theatre towel.  The Radiologist will use the CT scanner to decide on the most suitable point for inserting the biopsy needle.  Then your skin will be anaesthetised with local anaesthetic, and the biopsy needed inserted into the abnormal tissue.  When the biopsy is taken, the needle that is used makes a sharp snapping sound.  Once an adequate sample has been obtained the needle will be removed.

How long will it take?

Every patient’s situation is different, and it is not always easy to predict how complex or straightforward the procedure will be. Generally, it may take 20-30 minutes, although you may be in the department for about an hour altogether.

Will it hurt?

When the local anaesthetic is injected, it will sting to start with, but this soon passes off, and the skin and deeper tissues should then feel numb.  Later, you may be aware of the needle passing into your body, but this is generally done so quickly, that it does not cause any discomfort at all.

There will be a nurse, or another member of clinical staff standing next to you and looking after you.  If the procedure does become painful for you, then they will be able to ensure the Radiologist is aware and more local anaesthetic can be given.

Are there any risks or complications?

This procedure is generally very safe.  However, there are a few risks and occasional complications that can arise.

• Air leak (pneumothorax). It is possible that air can get into the space around the lung.  This generally does not cause any real problems, but if it causes the lung to collapse, then the air will need to be drained, either with a needle, or with a small tube put in through the skin.  1 in 4 cases (25%) develop an air leak and the Radiologist will be looking for this complication throughout and after the procedure. If the air leak does not resolve on its own, a small tube (called a chest drain) is inserted into the lining of your lungs. This happens in approximately 5-10% of patients and does require an admission to hospital.

• Bleeding (haemorrhage). It is possible that some bleeding can occur due to the needle passing through blood vessels in the lung.  1 in 20 patients cough up some blood during or after the procedure, in general this is self-limiting.  If it persists then oxygen therapy and bronchoscopy may be required.  Bleeding can occasionally occur

• Air embolism.  The incidence of air embolism is unknown, it is an extremely rare complication, but it is serious and potentially life threatening complication. This occurs when air enters a blood vessel and travels to the brain or heart, where it can act like a clot. There is specific treatment for this rare complication and the radiologist will look for this complication on any post procedure imaging.

Despite these possible complications, a percutaneous biopsy is normally very safe, and is designed to save you from having a bigger procedure.

What happens afterwards?

You will be observed in the Radiology department for 2-3 hours following the procedure and a chest X-ray will be taken during this time.  The majority of people are able to go home after this although a small number will need further observation as an in-patient in the hospital.  If a chest drain is required you may have to stay in hospital for slightly longer, until the lung and lung lining have healed.

 You will not be given the results of the biopsy on the day of the appointment.   It takes 7-10 days for the pathologist to do all the necessary tests on the biopsy specimen.  The results will be sent to the consultant in charge of your care.

You will NOT be allowed to drive, use public transport, or walk home.  You will also be unable to drive for the following 24 hours after your biopsy.  Please make sure there is a responsible adult to collect you, escort you home and stay with you for the rest of the day and overnight. If you cannot arrange this, please contact us on the number below.

We recommend that you do not fly for 6 weeks after the biopsy, in view of the slightly increased risk of your lung collapsing

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the CT Department (01482) 622043

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.