NCCN Guidelines for Patients
: Lung Cancer Screening
To test for cancer, tissue from the nodule must be
removed from your body. The tissue will then be sent to
a lab and examined with a microscope to look for cancer
cells. A biopsy removes small samples of tissue. Surgery
removes the entire nodule for testing.
Since a biopsy only removes a very small piece of the
nodule, the results could be wrong. There may be cancer
cells in another part of the nodule. Thus, your doctors
may suggest surgery instead of a biopsy if your risk
for cancer is high. Likewise, your doctors may suggest
another biopsy or surgery if the first biopsy shows no
There are two types of biopsies used for lung nodules.
Before either biopsy, you may be asked to stop eating,
stop taking some medicines, or stop smoking. A sedative,
local anesthesia, or both may be used. A biopsy is
generally a safe test and takes about 30 to 60 minutes to
Percutaneous needle biopsy
This biopsy uses a very thin needle. Before or during the
biopsy, CT may be used to find the right spot. Your skin
will be cleaned and your doctors will make a small cut
after numbing the area with local anesthesia. The needle
will be inserted through the cut and into the nodule.
During the biopsy, you may be asked to keep still and
hold your breath at times. After the biopsy, you will be
given a chest x–ray to check the results.
A bronchoscopy allows your doctor to biopsy a nodule
using a bronchoscope. A standard bronchoscope is a
thin, long tube about as thick as a pencil. It has a very
small light, camera, and open channel for taking biopsies.
The light and camera allow your doctor to guide the
bronchoscope down your mouth into your lungs. A small
tool is used to remove tissue from the nodule.
The airways of the lungs get smaller as they extend
toward the side of the body. Standard bronchoscopes are
often too large to travel through these small airways. A
navigational bronchoscopy can be done instead to guide
a probe and biopsy instrument to the site of the nodule.
For a navigational bronchoscopy, your doctor will plan
how to reach the nodule using a picture made by CT.
During the biopsy, you will lie on an electromagnetic
plate. The bronchoscope will be fitted with another very
small tube through which a sensor probe will be inserted.
The electromagnetic plate allows your doctor to see and
guide the sensor probe. When the nodule is in reach,
the sensor probe will be removed and a small tool will be
inserted to collect tissue.
Surgery removes the nodule as well as a rim of normal-
looking tissue around the nodule. The normal tissue is
called the surgical margin. The whole nodule and the
surgical margin will be examined for cancer cells.
Part 5: Testing for lung cancer