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Lung biopsy

Biopsy
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Report in 240Hrs

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At Home

nofastingrequire

No Fasting Required

Details

Histopathology of lung tissue.

₹296₹423

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Lung Biopsy - Comprehensive Medical Test Guide

  • Why is it done?
    • A lung biopsy is a procedure that involves collecting a small sample of lung tissue for microscopic examination to diagnose various respiratory conditions and diseases.
    • Primary indications for ordering: • Diagnose interstitial lung diseases (idiopathic pulmonary fibrosis, sarcoidosis, hypersensitivity pneumonitis) • Identify lung infections (tuberculosis, fungal infections, atypical infections) • Evaluate abnormal lung masses or nodules suspicious for malignancy • Confirm lung cancer diagnosis and determine cancer type • Investigate persistent infiltrates of unknown etiology • Diagnose vasculitis or other autoimmune lung conditions • Assess immunocompromised patients with infiltrates
    • Typical timing or circumstances: • When imaging findings (CT scan, X-ray) are inconclusive • After non-invasive testing has failed to provide diagnosis • When clinical presentation suggests serious lung pathology • Following initial diagnosis to confirm disease type or staging • In acute or chronic respiratory symptoms requiring urgent diagnosis • When treatment decisions depend on histological confirmation
  • Normal Range
    • Normal/Reference findings: • Normal histological architecture of lung parenchyma • Preserved alveolar structure with normal alveolar walls • Minimal inflammation (less than 5% inflammatory cells) • Normal bronchiolar tissue without stenosis • Absence of malignant cells • Normal connective tissue without fibrosis • No infectious organisms identified (bacteria, fungi, viruses) • Normal vasculature without vasculitis • Appropriate elastic tissue distribution
    • How to interpret results: • Normal/Benign: Tissue shows normal lung architecture with no disease process • Positive findings: Abnormal cells, inflammation, fibrosis, or organisms present • Borderline/Inconclusive: Findings may require repeat sampling or additional testing • Malignant: Presence of cancer cells with specific typing and grading • Infectious: Identification of specific pathogens • Inflammatory: Evidence of interstitial lung disease or autoimmune process
    • Units of measurement: • Microscopic examination at 40x to 400x magnification • Tissue samples measured in millimeters • Percentage of affected tissue or cellular involvement • Grading systems specific to disease type (Ashcroft score for fibrosis, histological grade for malignancy)
  • Interpretation
    • Detailed interpretation of different findings: • Usual Interstitial Pneumonia (UIP): Progressive fibrosis pattern typical of idiopathic pulmonary fibrosis • Non-Specific Interstitial Pneumonia (NSIP): Inflammation and uniform fibrosis suggesting connective tissue disease • Organizing Pneumonia: Plugs of fibroblasts in airways indicating recent or recurrent lung injury • Granulomatous Inflammation: Presence of granulomas suggesting sarcoidosis, tuberculosis, or fungal infection • Malignant cells: Type classification (adenocarcinoma, squamous cell, small cell) and grade assignment • Acute lung injury: Diffuse alveolar damage indicating acute respiratory distress • Infections: Specific organism identification with staining techniques (acid-fast, fungal stains)
    • Clinical significance of result patterns: • UIP pattern: Progressive disease with poor prognosis; indicates need for early intervention • NSIP pattern: Generally better prognosis than UIP; may respond to immunosuppressive therapy • Granulomas without organisms: Suggests sarcoidosis or other systemic disease • Malignant findings: Determines stage, guides treatment strategy, and establishes prognosis • Infectious organisms: Determines specific antimicrobial therapy required • Minimal inflammation: Rules out active inflammatory disease • Tissue diagnosis: Essential for ruling out malignancy or confirming clinical suspicion
    • Factors that may affect readings: • Sample size and quality (larger, multiple samples provide better diagnostic accuracy) • Specimen processing and fixation technique • Staining method used (routine H&E, special stains, immunohistochemistry) • Prior biopsy or intervention affecting tissue architecture • Recent infection or inflammation masking underlying pathology • Medication effects (corticosteroids may alter inflammatory patterns) • Patient age and smoking history relevance to diagnosis • Pathohistologist experience with specific lung pathology • Location of biopsy within lung (different regions may show different patterns)
  • Associated Organs
    • Primary organ system involved: • Respiratory system (lungs and pulmonary parenchyma) • Pleura (outer lining of lungs may be involved) • Airways (bronchi and bronchioles) • Pulmonary vasculature
    • Medical conditions commonly associated with abnormal results: • Idiopathic Pulmonary Fibrosis (IPF): Progressive scarring of lung tissue • Lung Cancer: Primary adenocarcinoma, squamous cell, small cell carcinoma, mesothelioma • Sarcoidosis: Systemic granulomatous disease affecting lungs • Tuberculosis and atypical mycobacterial infections • Fungal infections (histoplasmosis, coccidioidomycosis, blastomycosis) • Hypersensitivity Pneumonitis: Immune reaction to inhaled antigen • Connective Tissue Disease-Associated ILD: Rheumatoid arthritis, scleroderma, lupus • Acute Respiratory Distress Syndrome (ARDS) • Viral infections (COVID-19, influenza, cytomegalovirus) • Lymphangitic carcinomatosis • Pneumocystis pneumonia (PCP) in immunocompromised patients • Pulmonary vasculitis (ANCA-associated vasculitis) • Environmental/occupational lung diseases (asbestosis, silicosis)
    • Potential complications and risks associated with abnormal results: • Cancer diagnosis: Emotional impact, need for oncologic treatment, potential systemic spread • Progressive fibrosis: Deteriorating lung function requiring oxygen therapy and advanced interventions • Severe infections: May require intensive antimicrobial therapy or hospitalization • Autoimmune/inflammatory conditions: Chronic disease management and immunosuppression • Procedural risks: Pneumothorax (1-5%), bleeding, infection at biopsy site • Need for repeat biopsies: If initial sample inconclusive • Hospitalization requirements: For more invasive biopsy techniques • Respiratory compromise: Especially in patients with underlying lung disease
  • Follow-up Tests
    • Additional tests based on biopsy findings: • If malignancy diagnosed: - PET-CT scan for staging and metastasis detection - Brain MRI for brain metastases - Bone scan if indicated - Molecular testing (EGFR, ALK, PD-L1) for therapy selection • If infection identified: - Culture and sensitivity testing - Blood cultures if bacteremia suspected - Repeat sputum or bronchoalveolar lavage cultures • If interstitial lung disease: - High-Resolution CT (HRCT) for pattern confirmation - Pulmonary function tests (PFTs) - Six-minute walk test • If sarcoidosis suspected: - Serum angiotensin-converting enzyme (ACE) level - Serum and urine calcium - Chest imaging surveillance • If vasculitis suspected: - ANCA serology (c-ANCA, p-ANCA) - Anti-GBM antibodies - Rheumatologic workup
    • Monitoring frequency for ongoing conditions: • Lung cancer: Every 3-6 months imaging; quarterly oncology visits during treatment; annual follow-up after treatment • Interstitial lung disease: Every 6-12 months with imaging and PFTs to assess progression • Active infection: Weekly to monthly follow-up until clinical improvement; repeat cultures as needed • Sarcoidosis: Annual imaging and labs; more frequent if symptomatic or progressive • Autoimmune diseases: Every 3-6 months depending on disease activity and treatment • Post-procedure: Chest X-ray within 4 hours to rule out pneumothorax
    • Related complementary tests: • Bronchoscopy with bronchoalveolar lavage (BAL) • High-Resolution CT (HRCT) of chest • Pulmonary function tests (spirometry, diffusing capacity, lung volumes) • Arterial blood gas analysis • Six-minute walk test with oxygen saturation monitoring • Chest X-ray (baseline and follow-up) • Immunophenotyping by flow cytometry • Molecular and genetic testing (mutation analysis) • Transbronchial lung biopsy if smaller sample needed • Video-assisted thoracoscopic surgery (VATS) biopsy for larger samples
  • Fasting Required?
    • Fasting requirement:Yes - Fasting is required before lung biopsy
    • Fasting duration and instructions: • Minimum 6-8 hours fasting before procedure • Nothing to eat after midnight for morning procedures • Clear liquids may be allowed up to 2-3 hours before procedure (check with provider) • No food, beverages, gum, or hard candies after fasting period begins • Swallow small sips of water with medications if absolutely necessary
    • Medications to avoid: • Anticoagulants (warfarin, apixaban, rivaroxaban, dabigatran): Typically held 3-7 days before • Antiplatelet agents (aspirin, clopidogrel, NSAIDs): Usually discontinued 5-7 days before • Blood thinners and anticoagulants: Consult provider about discontinuation timeline • Discuss all medications with proceduralist prior to procedure • Continue essential medications (beta-blockers, blood pressure medications) with small sip of water • Do NOT take morning medications unless specifically instructed
    • Other patient preparation requirements: • Laboratory work: Recent complete blood count (CBC), coagulation studies (PT/INR, PTT), kidney and liver function • Physical examination and medical clearance before procedure • Informed consent discussing risks and benefits • Pre-operative assessment for anesthesia if procedure requires sedation • Arrange transportation: Cannot drive after sedation for 24 hours • Remove dentures, contact lenses, jewelry, and hearing aids • Wear comfortable, loose clothing without buttons or metal fasteners • Notify provider of allergies, especially iodine or latex • Report active infections or fever to provider • Notify provider of pregnancy or possible pregnancy • Baseline vital signs and oxygen saturation measured • Chest X-ray may be obtained immediately after procedure to assess for pneumothorax • Have responsible adult available for pickup following sedated procedures

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