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Image Guided Lung Biopsy

A needle biopsy, also called a needle aspiration, involves removing some cells-either surgically or in a less invasive procedure involving a hollow needle-from a suspicious area within the body and examining them under a microscope to determine a diagnosis. In a needle biopsy of lung nodules, imaging techniques such as computed tomography (CT) and fluoroscopy are often used to help guide the interventional radiologist's instruments to the site of the abnormal growth.

Your doctor may recommend an Image Guided Needle Lung Biopsy if imaging studies cannot clearly define the abnormality. When a physician orders a needle biopsy, the nodule is usually believed to be unreachable by other diagnostic techniques.

You may be instructed not eat or drink for eight hours before your biopsy. However, you may take your routine medications with sips of water. If you are diabetic and take insulin, you should talk to your doctor as your usual insulin dose may need to be adjusted. You may want to have a relative or friend accompany you and drive you home afterward. This is recommended if you have been sedated.

A biopsy needle is generally several inches long and the barrel is about as wide as a large paper clip. The needle is hollow so it can capture the tissue specimen.

One of two instruments will be used:

  • A fine needle attached to a syringe, smaller than needles typically used to draw blood.
  • A core needle, also called an automatic, spring-loaded needle, which consists of an inner needle connected to a trough, or shallow receptacle, covered by a sheath and attached to a spring-loaded mechanism.
  • Needle biopsies are often performed with the guidance of computed tomography (CT), fluoroscopy or ultrasound.

CT
The CT scanner is typically a large, box-like machine with a hole, or short tunnel, in the center. You will lie on a narrow examination table that slides into and out of this tunnel. Rotating around you, the X-ray tube and electronic X-ray detectors are located opposite each other in a ring, called a gantry. The computer workstation that processes the imaging information is located in a separate room, where the technologist operates the scanner and monitors your examination.

Fluoroscopy
The equipment typically used for this examination consists of a radiographic table, an X-ray tube and a television-like monitor that is located in the examining room or in a nearby room. When used for viewing images in real time (called fluoroscopy), the image intensifier (which converts X-rays into a video image) is suspended over a table on which the patient lies. When used for taking still pictures, the image is captured either electronically or on film.

Using imaging guidance, the physician inserts the needle through the skin, advances it into the lesion.

  • Tissue samples will then be removed using one of two methods.
  • In a fine needle aspiration, a fine gauge needle and a syringe withdraw fluid or clusters of cells.
  • In a core needle biopsy, the automated mechanism is activated, moving the needle forward and filling the needle trough, or shallow receptacle, with 'cores' of tissue. The outer sheath instantly moves forward to cut the tissue and keep it in the trough. This process is repeated three to six times. This procedure is usually completed within one hour.

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