NCCN Guidelines for Patients
: Non-Small Cell Lung Cancer
Part 3: Testing for lung cancer
If your doctors think a lung nodule is cancer, their choice
of a biopsy instead of surgical treatment is based on
many factors. You may have a biopsy at the time of
surgery if your doctors strongly think that the nodule is
cancer and hasn’t spread far. Otherwise, you will have a
biopsy to plan which treatment is best for you. The types
of biopsies for cancer in or near the lung are described
next. If there’s likely lung cancer that has spread to
distant sites, a biopsy of the distant site should be done
You may have more than one biopsy to collect
enough cells to test for cancer and for changes
in genes for which there are treatments.
You will be given instructions to prepare for the biopsy.
You may be asked to stop eating, drinking, and taking
some medicines for a short period of time. If you smoke,
it is important to stop. Most biopsies are done within 30
to 60 minutes and don’t require staying overnight in a
3.1 Biopsies of lung tissue
Type of biopsy
Radial EBUS (
Open surgical biopsy
This biopsy uses a standard bronchoscope to collect
samples. The part of the bronchoscope that is inserted
into the body looks like a thin, long tube about as thick as
a pencil. There are two types of standard bronchoscopes.
A rigid bronchoscope is straight and doesn’t bend. A
flexible bronchoscope is thinner and longer and can
bend. It can reach the smaller airways of the lung.
General anesthesia is needed for a rigid bronchoscopy.
Local anesthesia is used for a flexible bronchoscopy.
Standard bronchoscopes have a light, camera, and open
channel. The light and camera allow your doctor to guide
the tube down your nose or mouth and see inside your
lungs. A small brush, needle, or tongs can be inserted
into the open channel to collect samples. Also, liquid may
be sprayed into the airway and then suctioned back up.
After the biopsy, you may feel some swelling and sound