I. Why is a puncture biopsy necessary? The purpose of puncture biopsy is to clarify the diagnosis and guide the next step of treatment. It is often easy to misdiagnose the nature of the disease based only on the imaging performance of the film. Even for patients who are highly suspected of having lung cancer, the pathology of the biopsy specimen is needed to understand the specific cytology type of lung cancer, the degree of differentiation, the sensitivity of targeted drug therapy and other related information. What is the purpose of pathologic testing of biopsy specimen? 1.Confirm whether it is cancer or not. The diagnosis can be confirmed if the cancer cells can be seen under the microscope, and some patients can clarify which type of cancer it is, which takes 3 to 5 working days. 2.Confirm which type of lung cancer it is and the degree of differentiation. Usually, a special pathology test (immunohistochemistry test) is needed to clarify the diagnosis, and the treatments for different types of lung cancer are different. This test is usually carried out after the first step (the step of “confirming whether it is cancer or not”), and the time required is 3 to 5 working days. Determine whether it is suitable to apply molecular targeted drug therapy. For specific types of lung cancer, targeted therapy has its advantages over chemotherapy, and is recommended for patients with financial conditions. However, this kind of drug cannot be taken blindly on an experimental basis, and the biopsy specimen needs to be subjected to a special test (genetic test), which is usually carried out after the second step (the step of “confirming the diagnosis of which type of lung cancer and the degree of differentiation”), and the time required is 3 to 5 working days. What are the commonly used clinical biopsies? Open thoracic biopsy or minimally invasive thoracoscopic biopsy: The disadvantage is that it is more traumatic than the other two types of biopsy, especially open thoracic biopsy. And these two ways need general anesthesia, so the patient is exposed to the risk of general anesthesia complications that may ensue. The advantage is that if the lesion in the lung is a single nodule or no metastasis is found for the time being, biopsy characterization + surgical resection can be completed at once. 2, fiberoptic bronchoscopy puncture biopsy: a hose is sent from the oropharynx, through the trachea, bronchial tube to the affected area, through the front end of the ultrasound probe to detect the location of the tumor for puncture biopsy, a little bit similar to do gastroscopy. It is somewhat similar to gastroscopy. It can be carried out in many hospitals and is the most widely used biopsy method. The disadvantage is that ultrasound often cannot observe the location and shape of the lesion clearly, which results in less and more fragmented pathological tissues taken out by puncture that cannot reach the pathological diagnostic standard, so it is easy to be misdiagnosed and underdiagnosed. 3. CT-guided puncture biopsy: CT scanning is the clearest imaging method for lung tumors, so CT-guided puncture biopsy is the clearest way to observe the lesion and the most accurate method of puncture, and the specimen from the biopsy is complete and the volume can basically meet the requirements of pathology-related diagnosis. However, since CT-guided approach requires puncture through the epidermis to the lung layer by layer, after a long distance, so the technical requirements are extremely high, compared with the first two biopsy methods can not be completed by every hospital and every doctor. The probability of possible complications is between the first two types of biopsy. What are the common complications of thoracic lesion biopsy? The most common complications are pneumothorax and pulmonary hemorrhage: Pneumothorax is caused by outside air passing through the puncture channel into the chest cavity where the pressure is low, much like a leak in a car tire. A small amount of pneumothorax does not cause serious discomfort or require any treatment. A large amount of pneumothorax (which occurs in patients with poor lung function, emphysema, and alveoli) requires drainage of the gas from the chest cavity. Usually, these treatments can be done conveniently and quickly in the puncture operating room, and very few patients need to be sent to the emergency room for observation. Pulmonary hemorrhage is caused by the puncture of a blood vessel. Normally, the tip of the needle does not puncture a small enough blood vessel to cause fatal hemorrhage, and the bleeding stops quickly, especially in patients with normal coagulation. Small amounts of pulmonary hemorrhage do not cause any symptoms, but if the blood flows into the terminal airways, it can cause the patient to hematemesis. Hemoptysis is common and usually decreases over time. Of course, there are more complications of lung puncture biopsy, and the detailed types, precautions, and treatments can be discussed in detail with the doctor during the outpatient evaluation, as well as the need to sign an informed consent form prior to the lung puncture biopsy procedure, which lists them in more detail. Overall, lung puncture biopsy is still safe and feasible. V. Will puncture biopsy stimulate the tumor and cause it to spread? This is a misconception that people have formed for a long time! The main reason for this false impression is that the preoperative examination is not comprehensive. Many tumor patients come to the clinic with local symptoms, and the tablets in hand are just a few. After doing the puncture biopsy with the continuous improvement of the examination found that the original many did not notice the metastasis of the place is now a problem, or previously asymptomatic place with the progress of the disease is now symptomatic, so naturally think that it is caused by the puncture biopsy. A normal human body carries thousands or more cancer cells within its bloodstream every day, but they are all cleared by its own immune system and do not form cancer. Tumor cells brought out by puncture biopsy are even more minimal, the probability of entering the blood circulation is extremely low, and the possibility of metastasis through the blood circulation is almost negligible. At present, the development of puncture technology and the improvement of puncture equipment have also made this technique more safe and almost eliminated the phenomenon of “pulling up the carrot and bringing up the mud” of the old biopsy method. What is the cost of thoracic lesion biopsy? Tip: Because of the different charges of each hospital, so do not list the specific price. 1.Pre-operation blood test1 (necessary items): including blood routine, biochemistry (liver and kidney function, blood sugar, etc.), coagulation function, infection screening (hepatitis B, hepatitis C, syphilis, AIDS). If the patient has recently had a blood test in a tertiary hospital and the result is normal, there is no need to re-test. 2.Pre-operation blood test 2 (required for some patients): tumor markers, A function, blood sedimentation, etc. 3.Pre-operation examination 1 (required items): chest CT (enhanced CT or plain CT), electrocardiogram. 4.Preoperative examination 2 (necessary items for some patients): patients with poor lung conditions or obvious wheezing need to do pulmonary function tests; patients with a history of heart disease need to do echocardiography, 24-hour ambulatory electrocardiogram (Holter), coronary artery CT, etc.; if you can’t see clearly on the films brought from outside hospitals, or if you judge that the disease has progressed, you need to redo the chest CT (enhanced CT or swept CT), chest MR (enhanced MR or swept MR), chest MR (enhanced MR or swept MR), and so on. (enhanced MR or scanned MR), PET-CT and so on. 5.Puncture biopsy surgery fee. If multiple parts of the body need to be biopsied at the same time, the cost will be different from that of single part biopsy. 6. Biopsy specimen testing fee. Previously introduced (II. Biopsy specimen pathology testing purposes?), different purposes of testing fees are different. The fees for different purposes of testing are different: routine pathology testing (“to confirm whether the diagnosis is cancer or not” and “to confirm which type of lung cancer is diagnosed and the degree of differentiation”) is cheaper; genetic testing (“to confirm whether it is suitable for Genetic test (“to confirm whether it is suitable to apply molecular targeted drug therapy”) is cheaper; genetic test (“to confirm whether it is suitable to apply molecular targeted drug therapy”) has different charges according to the number and types of testing items, and is generally more expensive.