When your doctor suspects you have lung cancer, he or she may recommend a lung puncture biopsy to obtain tissue from the lung lesion to help confirm the diagnosis and decide on follow-up treatment. When you hear “puncture,” you may be nervous that it will be painful and that it will cause “cancer to metastasize. In fact, the doctor will do a rigorous evaluation and careful preparation before the procedure, and as long as you cooperate and follow the doctor’s instructions, lung puncture is usually very safe.
What do I need to do before I have a lung puncture?
Before the test, your doctor will tell you and your relatives what the lung puncture means, what the procedure is, and what the possible risks are, so you can ask your doctor more if you have any questions at this time.
You usually cannot have a puncture if you have a severe coagulation disorder or bleeding disorder, are very weak, have severe emphysema, pulmonary heart disease, pulmonary hypertension, cardiac insufficiency, and pulmonary vascular disease, have a severe cough, or are unable to cooperate with your doctor.
If you are taking anticoagulant medication, you need to inform your doctor, who may recommend stopping the medication and holding off on the puncture to avoid serious bleeding.
To minimize complications from pulmonary puncture, your doctor will prepare and dispose of you well at all points of the test.
Before the puncture, your doctor will need to check your platelet count, coagulation, and other indicators, as well as an enhanced chest CT to determine if there are large blood vessels in and around the lesion. You should not be nervous and just keep your mind relaxed. If you are really nervous, you can inform your doctor, who may give you sedative medication before the puncture; if you cough a lot, your doctor may also give you cough suppressant medication so that you can better cooperate with the puncture.
What do I need to watch for during the puncture?
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During the puncture, the doctor will choose the right position and needle for the size of the lesion, and you will need to be in the right position for the doctor.
What do I do after the puncture
After the puncture, you will need to be observed for 2 to 4 hours to make sure you are not in significant discomfort (sometimes fluoroscopy, radiographs, or CT scans are needed to confirm that there is no abnormality) before you are allowed to go home or stay in the hospital for a short period of time.
What are the complications of a puncture biopsy? How can I manage them with my doctor?
All kinds of puncture tests are invasive and carry some risk. However, your doctor will be prepared to prevent and manage all of them, and you do not need to be overly concerned.
The literature reports a complication rate of about 7.5% for lung punctures. Pneumothorax (air from the lung entering the pleural cavity and causing pneumatization), bleeding, infection, pleural shock, air embolism, and “needle tract tumor implantation metastasis” (tumor metastasis via puncture, but it is very low) may occur. Among them, pneumothorax and hemorrhage are relatively more common. We briefly introduce them to you.
The incidence of pneumothorax is about 30% with lung puncture; it can be as high as 50% if it is combined with emphysema; the deeper the lesion, the more normal lung tissue the puncture needle has to pass through, and the greater the probability of pneumothorax. A small number of pneumothoraces can be closely observed and do not require treatment if they are asymptomatic, and most can be absorbed within a short period of time; in rare cases, a large number of pneumothoraces result in pulmonary compression and significant clinical symptoms, requiring closed chest drainage to facilitate gas expulsion.
The incidence of bleeding from lung puncture is relatively low, about 5%, mostly during puncture or just after removal of the puncture needle; small lesions tend to bleed more easily than large lesions, probably because small tumor lesions tend to be more actively proliferating and more vascular than large lesions. In addition, due to the need of the doctor to take the material, the puncture often penetrates the whole lesion, which easily punctures the proliferating tumor blood vessels and causes bleeding. The hemorrhage can usually be stopped with drug treatment.
There are also some uncommon complications. Air embolism is rare, mostly due to inadvertent penetration of the pulmonary veins. The incidence of needle tract tumor implantation and metastasis is even lower, and previous studies have confirmed that the probability is less than a few per 1,000, a rare event of very low probability, with only isolated case reports in the professional community, which can be avoided by the current clinical use of fine needles or aspiration negative pressure biopsy. Tension pneumothorax or hemorrhage may cause asphyxia, but this is very rare.
Also, you should be reminded that there are some conditions in which a lung puncture should not be performed.
Who should not have a puncture biopsy?
Pulmonary puncture biopsies usually cannot be done if you have a severe coagulation disorder or bleeding disorder, are very weak, have severe emphysema, pulmonary heart disease, pulmonary hypertension, cardiac insufficiency and pulmonary vascular disease, have a severe cough, or are uncooperative with your doctor.
If you are taking anticoagulant medication, be sure to tell your doctor, who may be able to take steps to hold off the puncture to avoid serious bleeding.
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Co-reviewed by: Guangdong Provincial People’s Hospital Guangdong Lung Cancer Institute Dr. Wang Zhen, Associate Chief Physician Dr. Liu Siyang