This is Part 2 of an educational series about lung biopsies. A lung biopsy is a medical procedure that removes a small piece of lung tissue to check it under a microscope for infection, scarring (fibrosis), cancer, etc. To view Part 1 which explains the types of biopsies relevant for pulmonary fibrosis, click here. Continue reading below to learn more about the potential benefits, risks, and alternatives of a lung biopsy.
Medical disclaimer: This article is intended for general educational purposes and is not a substitute for diagnosis or individualized medical advice. Decisions about lung biopsy should be made with a qualified pulmonologist or ILD specialist who understands your medical history, imaging, lung function and personal preferences.
What are the possible benefits?
A successful biopsy may:
- Establish a more confident diagnosis.
- Distinguish between diseases with different treatments.
- Prevent the use of an inappropriate medication.
- Provide information about the pattern and extent of lung injury.
- Help the medical team estimate prognosis and plan future care.
- End a prolonged period of diagnostic uncertainty.
These benefits are most meaningful when the biopsy result is likely to change what happens next. If every likely result would lead to the same treatment, the value of obtaining tissue may be limited.
What are the risks?
The risks depend on the type of biopsy, the patient’s lung function, overall health, whether the procedure is elective and the experience of the medical center. Possible complications of surgical lung biopsy include:
- An acute worsening or exacerbation of the underlying ILD
- Pneumonia or another respiratory infection
- Bleeding
- A persistent air leak from the lung
- Pain or numbness around the incisions
- Complications from general anesthesia
- A non-diagnostic result
- Death
Note that short-term mortality is estimated at approximately 1.7% for elective surgical lung biopsies. The risk is substantially higher when the procedure is performed urgently in someone who is hospitalized or whose disease is rapidly worsening. These numbers describe groups of patients and cannot predict one person’s individual risk. Factors that may increase risk include:
- Advanced age or frailty
- Significant oxygen requirements
- Severely reduced lung function
- Pulmonary hypertension
- Serious heart, kidney, liver or other medical conditions
- Rapidly progressive ILD
- Current hospitalization
- Higher-dose corticosteroid treatment
- Poor functional status
For someone with mild disease and otherwise good health, the balance may be very different than it is for someone with advanced fibrosis, pulmonary hypertension and high oxygen needs.
How should the risks and benefits be weighed?
A useful decision begins with three questions:
- How uncertain is the current diagnosis? Ask what diagnoses the doctors are considering and how confident they are in the leading diagnosis without a biopsy. “Uncertain” can mean different things. A team may be 80% confident in one diagnosis or may be deciding among three equally possible conditions. Those situations may lead to different recommendations.
- How would the biopsy result change treatment? Ask the doctor to describe what would happen under each likely result. For example: If the biopsy shows IPF, what treatment would be recommended? If it shows hypersensitivity pneumonitis or another inflammatory ILD, what would change? Is there a realistic biopsy result that would lead to a different medication? Would treatment remain the same even without tissue? If the answer is that the biopsy is unlikely to change management, it is reasonable to ask why the procedure is still being recommended.
- What is the individual procedural risk? Ask for an assessment based on age, lung function, oxygen requirements, pulmonary hypertension, other health conditions and whether the procedure is being performed electively. The relevant question is not whether lung biopsy is generally safe. It is whether the likely diagnostic benefit outweighs the risk for that particular patient.
The importance of multidisciplinary review
ILD diagnosis is often most accurate when the case is reviewed by a multidisciplinary team. This may include an ILD pulmonologist, a chest radiologist experienced in ILD, a pulmonary pathologist, a rheumatologist when autoimmune disease is possible, and/or thoracic surgeon or interventional pulmonologist when biopsy is being considered. Together, the team reviews the history, exposures, medications, autoimmune testing, lung function, CT images and any available tissue.
Before agreeing to a biopsy, patients may want to ask whether their case has been reviewed in an ILD multidisciplinary conference. A second opinion from an ILD specialty center can also be helpful, particularly when surgical biopsy is being considered.
Questions to ask before deciding
Consider bringing these questions to the next appointment:
-
- What diagnoses are you trying to distinguish?
- How confident are you in the current diagnosis without a biopsy?
- Is the CT scan definite, probable, indeterminate or suggestive of another diagnosis?
- How would each possible biopsy result change my treatment?
- Could bronchoscopy, bloodwork, exposure testing or another less-invasive test provide the information?
- Is cryobiopsy an appropriate alternative in my case?
- What are the risks based on my lung function and overall health?
- How many ILD biopsies does this medical center perform?
- Will an experienced pulmonary pathologist review the samples?
- Has my case been discussed by a multidisciplinary ILD team?
- What are the advantages and disadvantages of treating or monitoring without a biopsy?
- Is there enough time to obtain a second opinion?
Asking these questions does not mean refusing care. It is part of making an informed decision.
There is no single right choice for everyone
For one person, a biopsy may provide essential information that leads to the correct treatment. For another, imaging and clinical findings may already provide enough certainty. For someone with advanced disease or major health risks, the potential harm may outweigh what the biopsy is likely to add. The decision should be individualized and shared between the patient and an experienced medical team.
If you are uncertain, ask your doctor to explain—in plain language—what the biopsy is expected to answer, how the answer could change your care and what risks apply specifically to you. Those three pieces of information can make an overwhelming decision much easier to understand.
To learn more about related topics:
- Read about pulmonary function tests (PFTs) here.
- Read about anesthesia here here.
- Sign up for support group: https://pulmonaryfibrosisnow.org/sign-up-form/
- Join our community forum: https://www.facebook.com/groups/1198991686930106
Leave a comment