the excision of a small amount of tissue, may be per-formed to permit
examination of cells from the pharynx, larynx, and nasal passages. Local,
topical, or general anesthesia may be administered, depending on the site and
the procedure (see also “Lung Biopsy Procedures” below).
biopsy is accomplished by needle biopsy of the pleura or by pleuroscopy, a
visual exploration through a fiberoptic bron-choscope inserted into the pleural
space. Pleural biopsy is per-formed when there is pleural exudate of
undetermined origin and when there is a need to culture or stain the tissue to
identify tu-berculosis or fungi.
the chest x-ray findings are inconclusive or show pul-monary density
(indicating an infiltrate or lesion), biopsy may be performed to obtain lung
tissue for examination to identify the nature of the lesion. There are several
nonsurgical lung biopsy techniques that are used because they yield accurate
information with low morbidity: (1) transcatheter bronchial brushing, (2)
trans-bronchial lung biopsy, or (3) percutaneous (through-the-skin) needle
transcatheter bronchial brushing, a fiberoptic broncho-scope is introduced into
the bronchus under fluoroscopy. A small brush attached to the end of a flexible
wire is inserted through the bronchoscope. Under direct visualization, the area
under suspi-cion is brushed back and forth, causing cells to slough off and
ad-here to the brush. The catheter port of the bronchoscope may be used to
irrigate the lung tissue with saline solution to secure ma-terial for
additional studies. The brush is removed from the bron-choscope and a
microscopic slide is made. The brush may be cut off and sent to the pathology
laboratory for analysis.
procedure is useful for cytologic evaluations of lung le-sions and for the
identification of pathogenic organisms (Nocar-dia,
Aspergillus, Pneumocystis carinii, and other pathogens). It isespecially
useful in the immunologically compromised patient.
transbronchial lung biopsy uses biting or cutting forceps in-troduced by a
fiberoptic bronchoscope. A biopsy is indicated when a lung lesion is suspected
and the results of routine sputum samples and bronchoscopic washings are
method of bronchial brushing involves the introduc-tion of the catheter through
the transcricothyroid membrane by needle puncture. After this procedure, the
patient is instructed to hold a finger or thumb over the puncture site while
coughing to prevent air from leaking into the surrounding tissues.
needle biopsy may be accomplished with a cut-ting needle or by aspiration with
a spinal-type needle that pro-vides a tissue specimen for histologic study.
Analgesia may be administered before the procedure. The skin over the biopsy
site is cleansed and anesthetized and a small incision is made. The biopsy
needle is inserted through the incision into the pleura with the patient
holding the breath in mid-expiration. Using fluoro-scopic monitoring, the surgeon
guides the needle into the pe-riphery of the lesion and obtains a tissue sample
from the mass. Possible complications include pneumothorax, pulmonary
hem-orrhage, and empyema.
the procedure, recovery and home care are similar to those for bronchoscopy and
thoracoscopy. Nursing care involves mon-itoring the patient for shortness of
breath, bleeding, and infec-tion. In preparation for discharge, the patient
and/or family is instructed to report pain, shortness of breath, visible
bleeding, or redness of the biopsy site or pus to the health care provider
immediately. Patients who have undergone biopsy are often anx-ious because of
the need for the biopsy and the potential find-ings; the nurse must consider
this in providing postbiopsy care and teaching.
scalene lymph nodes are enmeshed in the deep cervical pad of fat overlying the
scalenus anterior muscle. They drain the lungs and mediastinum and may show
histologic changes from in-trathoracic disease. When these nodes are palpable
on physical examination, a scalene node biopsy may be performed. A biopsy of
these nodes may be performed to detect lymph node spread of pulmonary disease
and to establish a diagnosis or prognosis in such diseases as Hodgkin’s disease,
sarcoidosis, fungal disease, tuberculosis, and carcinoma.
is the endoscopic examination of the medi-astinum for exploration and biopsy of
mediastinal lymph nodes that drain the lungs; this examination does not require
a thora-cotomy. Biopsy is usually performed through a suprasternal inci-sion.
Mediastinoscopy is carried out to detect mediastinal involvement of pulmonary
malignancy and to obtain tissue for diagnostic studies of other conditions (eg,
An anterior mediastinotomy is thought to provide better ex-posure and diagnostic possibilities than a mediastinoscopy. An incision is made in the area of the second or third costal cartilage. The mediastinum is explored and biopsies are performed on any lymph nodes found. Chest tube drainage is required after the procedure. Mediastinotomy is particularly valuable to determine whether a pulmonary lesion is resectable.
Postprocedure care focuses on providing
adequate oxygenation, monitoring for bleeding, and providing pain relief. The
patient may be discharged a few hours after the chest drainage system is
removed. The nurse should instruct the patient and family about monitoring for
changes in respiratory status, taking into consid-eration the impact of anxiety
about the potential findings of the biopsy on their ability to remember those