When chest imaging studies identify a suspicious lung spot, a thin tube called a bronchoscope is inserted into the nose or mouth to reach the lungs. Tissue samples are obtained, and then sent to a lab to look for the presence of cancer cells. Unfortunately, the test isn’t always conclusive.
“We only get definitive answers 60 to 70 percent of the time,” said Dr. Momen Wahidi, MD, an interventional pulmonologist at Duke. Sometimes the cancerous tissue is too deep in the lungs for the bronchoscope to reach it.
When lung cancer can’t be ruled out following the bronchoscopy, the next step is to decide on further invasive tests. One option involves the placement of a long, thin needle through the chest wall. The procedure, which is called transthoracic needle aspiration, is performed by a radiologist, who uses CT images to guide the placement. Lung collapse can occur in 15 percent of cases.
Another option is to perform a surgical lung biopsy through an incision made in the chest. Lung collapse, bleeding and infection occur in five percent of cases.