Medical Health Encyclopedia

Needle Aspiration. Sometimes, a biopsy specimen is obtained by inserting a needle between the ribs, and then guiding it with the use of computed tomography scans, ultrasound, or fluoroscopy (a device allowing an X-ray view). Specific techniques include transbronchial or transthoracic needle aspiration (TBNA or TTNA) or endoscopic ultrasound-guided needle aspiration (EUS-NA). Their use depends on how much of the area can be observed with less invasive imaging techniques. There is a 5% to 10% risk for bleeding or collapsed lung with this technique.

Thoracoscopy. Thoracoscopy is usually very effective for diagnosing peripheral cancer or those involving the pleura (membrane surrounding the lungs). This is a surgical procedure that uses a fiber-optic tube to view the area:

• The procedure requires general anesthesia.
• Small incisions are made in the chest, through which the surgeon passes surgical instruments and a fiber-optic tube with a camera to allow visualization of the lungs on a video screen.

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Bronchoscopy. To locate cancer that develops in the central areas and major airways of the lung, usually squamous or small cell cancer, bronchoscopy is typically performed. The procedure is as follows:

• The patient is given a local anesthetic, supplementary oxygen, and sedatives.
• The doctor inserts a bronchoscope, a hollow flexible tube often containing a fiber-optic light source, into the lower respiratory tract through the nose or mouth.
• The tube acts like a telescope into the body, allowing the physician to view the wind pipe and major airways. (In a procedure called fluorescence bronchoscopy, the patient is injected with a drug that makes cancer tissue appear red when exposed to laser light from the bronchoscope.)
• The surgeon removes specimens for biopsy, ideally using a combination of techniques that include cutting tissue, using brushings, and using a washing process called bronchoalveolar lavage (BAL). BAL involves injecting saline through the bronchoscope into the lung and then immediately suctioning the fluid back through the hollow tube of the bronchoscope; the fluid is then analyzed in the laboratory. (Both brushing and washing procedures may be very valuable additions.)