Lung Resection Biopsy

Biopsy

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No Fasting Required

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Histopathology of lung tissue.

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Lung Resection Biopsy - Comprehensive Medical Guide

Why is it done?
- Surgical removal and examination of lung tissue to obtain a definitive diagnosis when other diagnostic methods have been inconclusive or non-diagnostic
- Diagnosis of suspected lung cancer or malignant lesions with histopathological confirmation
- Evaluation of persistent pulmonary nodules or masses visible on imaging (CT, X-ray) that cannot be characterized as benign
- Assessment of interstitial lung disease or idiopathic pulmonary fibrosis when clinical and radiological findings are non-specific
- Detection of infectious diseases, including fungal or mycobacterial infections, when other diagnostic methods have failed
- Identification of rare pulmonary conditions such as sarcoidosis, hypersensitivity pneumonitis, or lymphangitic carcinomatosis
- Staging of known lung cancer to determine extent of disease and guide treatment planning
- Therapeutic intervention - removal of localized lung lesions while obtaining tissue for diagnosis
Normal Range
- Normal Result: Normal lung tissue with no evidence of malignancy, infection, or pathological changes; benign findings
- Histopathological Interpretation: Microscopic examination shows normal bronchial epithelium, alveolar tissue, and supporting structures without atypia or dysplasia
- Benign Diagnoses Include: Hamartoma, granulomatous inflammation, inflammatory pseudotumor, non-specific inflammation
- Negative for Malignancy: No atypical or abnormal cells; no evidence of neoplastic disease
- Culture Results: No growth of pathogenic organisms; negative for bacterial, fungal, or mycobacterial infection
Interpretation
- Malignant Findings: Presence of cancer cells indicates primary lung cancer (adenocarcinoma, squamous cell carcinoma, small cell carcinoma, large cell carcinoma) or metastatic disease; histological grade and type determined for prognosis and treatment planning
- Molecular and Genetic Testing: Tissue may be analyzed for EGFR mutations, ALK rearrangements, PD-L1 expression, KRAS mutations, and other markers to guide targeted therapy and immunotherapy decisions
- Infectious Agents: Identification of organisms (Mycobacterium tuberculosis, fungal species, atypical bacteria) confirms diagnosis of pulmonary infection and guides antimicrobial therapy
- Inflammatory Conditions: Presence of non-caseating granulomas supports sarcoidosis diagnosis; inflammatory cell infiltration and fibrosis patterns help diagnose hypersensitivity pneumonitis or other interstitial lung diseases
- Fibrotic Changes: Evidence of pulmonary fibrosis, architectural remodeling, and traction bronchiectasis indicates idiopathic pulmonary fibrosis or other fibrotic interstitial pneumonias
- Factors Affecting Interpretation: Tissue adequacy and sampling location; fixation quality; presence of crush artifact; pathologist expertise; clinical correlation with imaging and patient history essential for accurate diagnosis
- Staging Information: Histological type and grade, presence of lymphovascular invasion, pleural involvement, and margins status all contribute to TNM staging and prognosis
Associated Organs
- Primary Organ System: Respiratory system; specifically the lungs with potential involvement of pleura, bronchi, and mediastinal lymph nodes
- Associated Diseases: Lung cancer (adenocarcinoma, squamous cell, small cell, large cell), sarcoidosis, idiopathic pulmonary fibrosis, hypersensitivity pneumonitis, tuberculosis, fungal infections (histoplasmosis, coccidioidomycosis, blastomycosis, aspergillosis), atypical mycobacterial infections, lymphangitic carcinomatosis, bronchiectasis
- Potential Complications: Respiratory failure if extensive lung tissue removed; pneumothorax; air leak from bronchial stump; hemorrhage; infection; bronchopleural fistula; empyema; atelectasis; prolonged air leak; acute respiratory distress syndrome in high-risk patients
- Systemic Effects: Abnormal results indicating malignancy may indicate systemic disease with potential metastases to liver, bone, brain, and adrenal glands; infectious diseases may have systemic manifestations; inflammatory conditions may be associated with extrapulmonary involvement
Follow-up Tests
- If Malignancy Diagnosed: CT chest/abdomen/pelvis for staging; brain MRI to rule out brain metastases; PET-CT scan for distant metastases; bone scan if indicated; mediastinal lymph node assessment; pulmonary function tests pre-operatively; cardiopulmonary exercise testing if marginal lung reserve
- Molecular Testing: EGFR, ALK, ROS1, KRAS, BRAF, MET mutations; PD-L1 immunohistochemistry; liquid biopsy (circulating tumor DNA) for treatment selection and monitoring
- If Infection Identified: Antimicrobial susceptibility testing; repeat imaging after treatment to assess response; blood cultures if systemic infection suspected; repeat bronchoscopy or imaging to confirm resolution
- If Inflammatory/Fibrotic Disease: Serial high-resolution CT imaging; pulmonary function tests (FVC, DLCO); six-minute walk test; immunosuppressive therapy monitoring; follow-up imaging every 3-6 months initially, then annually
- Post-Surgical Monitoring: Chest X-ray 24-48 hours post-surgery; pulmonary function tests 4-6 weeks post-operatively; chest imaging every 3-6 months for first 2 years if cancer; then annual surveillance
- Surveillance Schedule: If lung cancer: CT imaging every 3-6 months for years 1-3, then every 6-12 months; clinic visits with imaging at each follow-up; cessation of smoking strongly encouraged; palliative or chemotherapy/immunotherapy depending on stage and fitness
- Complementary Tests: Transbronchial biopsy, transthoracic needle aspiration, bronchoalveolar lavage, endobronchial ultrasound, endoscopic ultrasound, video-assisted thoracic surgery (VATS) if diagnosis still unclear
Fasting Required?
- Fasting: Yes
- Fasting Duration: Minimum 6-8 hours prior to surgery; typically overnight (nothing after midnight if surgery scheduled for morning)
- NPO Status: Nothing by mouth (NPO) after midnight including water, chewing gum, mints, or candy; may take essential medications with small sip of water as directed by surgeon
- Medications: Avoid antiplatelet agents (aspirin, clopidogrel) 5-7 days prior if possible; continue beta-blockers and antihypertensives unless directed otherwise; hold anticoagulants per surgeon's protocol; discuss all medications with surgical team
- Pre-Operative Preparation: Baseline lab work (CBC, BMP, PT/INR, type & cross); EKG; pulmonary function tests; baseline chest X-ray; anesthesia consultation; cessation of smoking for minimum 2-4 weeks prior if possible; removal of dentures, prosthetics, jewelry, makeup, and nail polish day of procedure
- Post-Operative Instructions: Clear liquid diet initially upon return from anesthesia; advance diet as tolerated; adequate pain control with prescribed analgesics; keep chest dressing clean and dry; monitor for signs of infection or complications; arrange follow-up appointment for pathology review and post-operative assessment
- Special Considerations: Patients with pulmonary hypertension or severe cardiac disease may require ICU monitoring post-operatively; patients with poor lung reserve may need extended mechanical ventilation; diabetic patients require blood glucose monitoring and insulin adjustment; pregnant patients require careful risk-benefit assessment

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