Lung Cancer Biopsy Types | Washington DC, Maryland, Virginia

Robotic diagnostic options make getting the answers you need easier and faster.

One of the most aggressive forms of cancer, lung cancer may continue to grow and spread into other areas of the body, causing other life-threatening problems. That's why it is important to detect, diagnose and treat it as early as possible. Now, with robotic-assisted, minimally-invasive diagnostic procedures, we can identify different types of lung cancer and diagnose it earlier when it is more easily treated.

Types of lung biopsies

If you have symptoms that might suggest lung disease or cancer or a chest x-ray reveals an abnormality that requires further testing, our interventional pulmonologists may perform a lung biopsy.

During a lung biopsy, interventional pulmonary experts (and sometimes thoracic surgeons) use several methods to remove a small tissue sample from the lung. This allows us to:

Evaluate the abnormality
Diagnose a condition (e.g., lung infection) or lung cancer
Stage lung cancer, or determine how far it has spread

Once we remove a sample of tissue, a pathologist will examine it under a microscope to determine if cancer is present. With the help of robotic bronchoscopy, we can even identify the stage of cancer at the same time of the biopsy, in some cases. We also conduct molecular profiling to identify any biomarkers or targets that can help us predict how your tumor will respond to certain therapies.

Several different procedures may be used to obtain this tissue, including:

Robotic navigational bronchoscopy

Doctors John Lazar and Jessica Wang Memoli stand and pose for a portrait in an operating room at MedStar Washington Hospital Center.

Robotic-assisted navigational bronchoscopy is an advanced technology that allows minimally invasive biopsies of lung nodules anywhere in the lungs, including places considered unreachable by other biopsy methods. The procedure replaces the need for high-risk invasive procedures, such as chest needle biopsies and open surgeries. As a result, robotic-assisted bronchoscopy sets the stage for earlier lung cancer diagnosis and, in some cases, can be combined with robotic-assisted thoracic surgery to remove the lung tumor on the same day. This boosts survival rates and eliminates the stressful wait-and-see approach after finding a questionable area on a thoracic CAT scan.

Other advantages to this type of biopsy include:

Significantly higher accuracy
Fewer complications
Improved survival rates
Reduced time to treatment

At MedStar Health, we use two different technological platforms to perform robotic-assisted bronchoscopy, including:

Auris MonarchTM Platform: We were the first healthcare facility in the mid-Atlantic to use this robotic platform to safely reach the deepest regions of the lungs where small nodules are typically found.
Ion Robot: We were one of the first in the U.S. to have the Ion Robot, which allows us to perform bronchoscopy to diagnose peripheral lung nodules, which are otherwise challenging to diagnose.

Regardless of the platform, robotic-assisted bronchoscopy can facilitate earlier, more accurate lung cancer diagnoses by offering unparalleled:

Reach: Its ultra-thin catheter and integrated vision probe provide the physician direct access and visibility into all parts of the lungs.
Precision: The shape-sensing technology provides precise location and shape information throughout the biopsy process. The system holds the catheter in place for precise placement of biopsy tools.
Flexibility: The catheter can move 180° in all directions with a highly flexible biopsy probe.

What to expect

Before robotic bronchoscopy, you'll undergo a computed tomography (CT) scan which will take detailed images of your lungs. These images will be used to plan a 3D map of the pathway to the lung nodule in the robotic software. This will provide turn-by-turn GPS navigation during the procedure, allowing us to safely navigate to even the smallest lesions deep in the lungs.

During the bronchoscopy, an interventional pulmonologist and thoracic surgeon use robotic-assistance to steer a thin tube with a tiny camera and light source to the biopsy site. They're able to visualize the actual airways and lungs on the robotic display the entire time, and enhanced stability ensures they can remain on target as the lungs are in motion while the patient breathes. Once they reach the lesion, they will use tiny surgical instruments to remove enough lung tissue for a quick biopsy.

Robotic-assisted navigational bronchoscopy takes about ninety minutes to perform and is a painless procedure done under general anesthesia.

Other minimally invasive lung biopsies

We use the least invasive means to collect lung tissue samples whenever we can. This reduces the risk of complications associated with an open lung biopsy. Other benefits include less pain and faster recovery time. The lung biopsy method we choose will vary based on the location and size of your lesion as well as your overall health.

Sputum cytology requires you to cough in a cup. Sputum (phlegm) is stained and examined under the microscope to look for malignant tumor cells.
During a thoracentesis, your doctor checks the fluid in your chest, also called the pleural fluid. The area is numbed, and a special biopsy needle is inserted into the chest to draw out some of the fluid.
Fine-needle aspirations require your physician to insert a biopsy needle into the tumor. Tissue samples are then removed from the abnormality inside your lungs or lymph nodes. In some cases, your doctor will recommend using a CT scan to guide the needle.
Traditional navigational bronchoscopy uses 3D electromagnetic guidance to help guide your surgeon to the larger lesions
Endobronchial ultrasound and endoscopic CT are advanced diagnostic technologies that provide real-time imaging of abnormalities inside the chest. These procedures are so effective that they can sometimes eliminate additional phases of testing. The real-time technology used in endoscopic CTs and endobronchial ultrasounds have a long learning curve, and few physicians are prepared to perform them. However, MedStar Health specialists are trained to perform these procedures with precision.

Surgical lung biopsies

Surgical lung biopsies allow us to diagnose and stage lung cancer tumors that require a larger piece of tissue. We may also use an open biopsy when other biopsy procedures have been unsuccessful.

A thoracoscopic lung biopsy lets your doctor view your lungs and chest cavity internally. Your doctor will make several small incisions in your chest and back and insert a lighted narrow tube to check for any abnormalities.
During a mediastinoscopy, your thoracic surgeon makes an incision at the top of the breastbone and inserts a thin, lighted tube to see inside the chest.
A thoracotomy, or open lung biopsy, is a procedure wherein a thoracic surgeon opens the chest with a long incision and removes any abnormalities or lymph nodes for further examination in the lab.

Learn More About Thoracic Surgery