CT guided needle biopsy (lung)

Introduction

This leaflet has been prepared to help you and your relatives understand more about your planned CT-guided needle biopsy. It will give you general information about what will happen during the procedure, what to expect while you are at Addenbrooke’s Hospital, and some information about what to do when you get home

A guided needle biopsy is a procedure that takes a small sample of cells from the lung or its lining, the pleura, to send to the laboratory for examination. The CT scanner allows the radiologist (X-ray doctor) to accurately locate the best place to access the sample required. The sample is obtained by inserting a needle through the chest wall and into the lung under local anaesthetic. The entire procedure takes place in the CT scanning room.

How long will I be in the department?

The procedure will take approximately 45 minutes.

The recovery time following your procedure will typically be 4 hours

What to do when you arrive

Please attend the Radiology Day Unit (RDU) where you will be checked in and the Nurse will get you ready for your procedure, insert a cannula and take blood which will be sent to the lab prior to your appointment in CT Scanning. Follow the instructions in your appointment letter.

Staff you are likely to meet

The Team will consist of radiology nurses, radiographers and a radiologist

Preparation for procedure/examination

In the morning you can have a light breakfast and tea / coffee before 07:00. Please take your usual medication. Those taking blood thinners, or who take diabetic medication should have received specific instructions; if you are unsure please phone either your nurse specialist or the radiology department on 01223 274287.

The procedure is planned to be a day case, and you will usually be able to go home a few hours after the procedure, but you must not drive yourself home, and you must be accompanied at home overnight following the procedure.. Occasionally however, you may be asked to stay in hospital that night so please bring an overnight bag with toiletries and nightwear in with you.

Benefits

Previous investigations, such as a chest X-ray or CT scan, have suggested an abnormality in your lungs needs further examination. A lung biopsy can help diagnose the cause of the abnormality, which will help the doctor to discuss with you whether you need further treatment

Risks

The decision to offer you a lung biopsy has been carefully considered by your doctors. A needle biopsy is considered a relatively safe procedure, but as with any procedure there may be small risks involved. The radiologist that performs the procedure will discuss these with you as part of the consenting process. The radiation dose is similar to that of other X-ray examinations and poses only a very small risk. Occasionally the sample is too small to fully evaluate.

Mild complications

It is common to have a small amount of bruising around the needle biopsy site and this will disappear naturally within a few days.

The biopsy site itself may feel a little sore which is to be expected and should settle after a few days. Occasionally there may also be bleeding from this area; if this doesn’t resolve after a period of ten minutes of applied pressure or you feel unwell or faint, please seek urgent medical attention.

More serious complications

When the biopsies are taken the puncture of the lung can cause a small air leak called a pneumothorax. This is where air can enter the chest cavity during the procedure causing part of the lung to collapse. It can cause a sharp pain in the chest and some shortness of breath. A small pneumothorax, which can occur in up to 25% of cases does not require any intervention and heals up itself. Occasionally (in approximately 5% of patients) there is a larger leak that may require a chest drain to be inserted. The chest drain is a thin tube that is inserted between two ribs under local anaesthetic and removes the trapped air allowing the lung to re expand. Insertion of a chest drain would require an overnight hospital stay. You may require admission for a few days, until it is safe to remove the chest drain, but this is rare.

A small amount of bleeding may occur from the lung when biopsies are taken. Some people cough up a little bit of blood during or shortly after the procedure. This should not be a cause for concern and should settle within a day or so. However, if it persists and you feel unwell or are unsure then please contact your GP. Please attend the Emergency Department immediately if symptoms are severe or you require immediate medical attention.

Very severe complications

Internal bleeding requiring an operation is very rare (1 in 1000 procedures)

Air embolism. Very rarely air can leak into the blood circulation following a lung needle biopsy and can cause chest pain or serious problems like heart attack or stroke. The risk of this complication occurring is around 1 in 3,000 procedures.

Death as a result of the procedure is extremely uncommon. The risk of this complication is around 1 in 5,000 procedures

What will happen on the day of my procedure/examination?

You will be admitted to the Radiology Day Unit, and from here you will be taken to the CT Scanning department. You will be dressed in a hospital gown. The radiologist (doctor) who will perform the biopsy will explain the procedure and answer any questions or concerns you may have.

Just before the biopsy is taken a CT scan of your chest will be performed. You may be asked to lie on the CT table on your back, front or side. The radiographers assisting with the procedure will make you as comfortable as possible, this is important to make sure you can lie still during the procedure.

It is important to lie very still, follow any breathing instructions and try not to cough during the test.

Once the exact location of the sample site has been identified your skin will be cleaned and a local anaesthetic will be injected to numb the area before a thin needle is passed into the lung. The local anaesthetic may sting a little for a short period of time. Following this the biopsy itself should not be painful, but may be uncomfortable and you may feel a pushing sensation. Often the radiologist will take two, three or four biopsies from the same area. The procedure usually takes around 30-45 minutes.

Accessibility requirements

If you require support for your appointment, e.g. if you find it hard to hear, see or be understood by others, please let the receptionist or healthcare professional know on arrival or contact us by email: cuh.accessibility@nhs.net or telephone: 01223 256998.

Pregnancy status

We have a legal responsibility to enquire if you are pregnant. Any patient aged between 12-55 years will be asked if there is a possibility they could be pregnant. This is important for us to know before you have your examination involving ionising radiation.

You can discuss this with a healthcare professional in private if you wish.

Medication

Bring all of your medicines (including inhalers, injections, creams, eye drops or patches) and a current repeat prescription from your GP

Can I bring someone with me?

There is limited waiting space in the Radiology Day Unit, so relatives or friends may be asked to leave the department and return once the procedure has completed.

Those accompanying you will not be allowed to stay in the examination room during the procedure.

Childcare whilst in department

Staff are unable to look after or supervise children whilst your procedure is taking place. Please make alternative arrangements for the care of your children whilst you attend for your procedure. If you attend an appointment with children with no one to look after them whilst you have your procedure, then your appointment will be cancelled and rescheduled.

Personal belongings

The Radiology Day Unit can lock away personal belongings otherwise they can be brought into the examination room.

What happens after my procedure/examination?

Once the procedure has finished you will be taken back to the Radiology Day Unit where you will recover and lie on your side or back for an hour. Shortly after this you will be able to eat and drink. Please tell the nurse if you have any pain. A routine chest X-ray will be performed approximately two hours after the biopsy. The X-ray will be checked by a doctor and if everything is ok you will be able to go home.

How, when and by whom will my results be communicated?

The results will be reviewed by your referring consultant and will be discussed with you once they are ready, this is usually around a week after the procedure

Are there any alternative tests?

In some cases it is possible to take a biopsy using a bronchoscope (a long narrow flexible tube) which is passed through the nose or mouth to reach the lungs. A biopsy can also be taken using a surgical procedure to reach the lung tissue. Your doctor will explain to you the reasons a needle biopsy has been chosen as opposed to the alternative options and will happily discuss these with you

Contacts/Further information

If you do have any concerns about your procedure, you can contact the CT department on 01223 217426.

The department is open from 7am – 7.30pm, Monday to Friday, and from 8.30am-4.30pm on Saturdays.

The Radiology Day Unit can be contacted on 01223 274287, 8am-8pm Monday to Friday

Facilities available

• There is a disabled toilet available
• There is a curtained, same-sex bay in the Radiology Day Unit.

Require leaflet in a different format or language?

The Recite Me toolbar makes our website digitally inclusive by allowing you to customise the contents so that it works best for you. It features an accessibility tools bar positioned at the top of webpage.

Key functions:

• Screen reader – option for all information on the website to be read aloud
• Translation – option to translate all information into over 100 different languages
• Styling and customisation – option to change the text, font style, size, colour and spacing so that the information is easier to read.
• Reading aids – including a screen mask (tint) and magnifier to help make the information more accessible for all.

Directions to the department

The Radiology Day Unit is located on Level 3 in the Outpatient part of the hospital.

Detailed instructions will be found in your appointment letter.

Question, concern or complaint?

Firstly speak to your nurse, doctor or other staff member as soon as you can so they can do their best to put things right straightaway.

If you don’t feel able to speak directly to the people caring for you, contact the patient advice and liaison service (PALS). Please call 01223 216756 9am to 4pm Monday to Friday, via email at cuh.pals@nhs.net, or via a form available via link on the CUH PALS webpage.

PALS is open every weekday, and you can leave a message in the evenings and weekends.

MyChart

We would encourage you to sign up for MyChart. This is the electronic patient portal at Cambridge University Hospitals that enables patients to securely access parts of their health record held within the hospital’s electronic patient record system (Epic). It is available via your home computer or mobile device

More information is available on our website: My Chart