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Bronchoscopy with Transbronchial Biopsy

What Is a Bronchoscopy with Transbronchial Biopsy?

Bronchoscopy is a diagnostic medical procedure. Your doctor can use it to see inside 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, as well as cancer. They can also use a lung biopsy to assess the stage of a known malignancy.

If your doctor performs a biopsy during your bronchoscopy, it may also be 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 X-ray 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 will be sprayed on your throat to numb it. 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 also be given an intravenous (IV) sedative to help you relax.

When your throat is numb, a flexible bronchoscope will be threaded through your trachea, or 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, but there’s no risk of suffocation.

There are two main types of bronchoscopes used to perform a bronchoscopy:

Rigid Bronchoscope

A rigid bronchoscope is often used when a foreign object is lodged in your throat or lungs. It can also be used when there’s excessive bleeding inside your 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.

Fiber-Optic Bronchoscope

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 will use 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. Tiny forceps will be used to take small samples of your lung tissue. 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 or CT scan. 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 six to 12 hours before your test. Your doctor may also ask you to avoid certain medications that thin your blood, such as aspirin. They can increase your risk of bleeding during or after your test.

Some of the medications that can thin the blood include:

  • aspirin
  • 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:

  • cough
  • 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 a much riskier, major surgery.

Complications of bronchoscopy are extremely rare. However, risks include:

  • an allergic reaction to sedatives
  • an infection
  • bleeding
  • 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 your lungs are healthy and that 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
  • granulomas
  • sarcoidosis
  • actinomycosis
  • bacterial infections
  • aspergillosis
  • cytomegalovirus (CMV) pneumonia
  • coccidiomycosis
  • fungal infections
  • histoplasmosis infections
  • Pneumocystis carinii pneumonia (PCP)
  • tuberculosis
  • mycobacterial infection
  • allergy-related lung inflammation, or hypersensitivity pneumonitis
  • rheumatoid lung disease
  • vasculitis

Content licensed from:

Written by: Sandy Calhoun Rice
Medically reviewed on: Feb 04, 2016: Steve Kim, MD

This feature is for informational purposes only and should not be used to replace the care and information received from your health care provider. Please consult a health care professional with any health concerns you may have.
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