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