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NCCN Guidelines for Patients



Lung Cancer Screening, Version 1.2017


How can you know for sure?



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 to remove the whole

nodule instead of a biopsy if your risk for cancer is

high. Likewise, your doctors may suggest another

biopsy, surgery, or frequent testing if the first biopsy

shows no cancer.

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 complete.

Percutaneous needle biopsy

This biopsy uses a very thin needle. Before and

during the biopsy, CT is 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, between the ribs and into the nodule. During the

biopsy, you may be asked to keep still and hold your

breath for a few seconds at a time. After the biopsy,

you will be given a chest x-ray to check for air that

can build up between the lungs and chest wall. This

kind of biopsy generally takes about an hour. You are

usually observed for 4 to 6 hours afterwards.


A bronchoscopy allows your doctor to biopsy

a nodule using a bronchoscope. A standard

bronchoscope has a thin, long tube about as thick

as a pencil. The tube 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

inserted down the channel to remove tissue from the


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.