Sarcoidosis is characterized by clumps of inflamed immune cells called granulomas. When these granumolas accumulate in certain organs or tissues, they can cause damage and affect the function of that particular organ or tissue.

One of the most common organs affected by sarcoidosis is the lungs, in which case the disease is called pulmonary sarcoidosis. If pulmonary sarcoidosis is suspected, a lung biopsy may be carried out, along with  other tests, as part of a diagnosis. Normally, a lung biopsy is recommended if an imaging scan, such as an X-ray or CT (computerized tomography) scan has revealed an abnormality.

What is a lung biopsy?

A lung biopsy is a procedure to remove a small piece of lung tissue. The tissue is then examined under a microscope to look for abnormalities that could indicate sarcoidosis.

Types of lung biopsy

There are several methods to obtain lung tissue.

Transbronchial biopsy

A transbronchial biopsy uses a bronchoscope, a thin and flexible tube with a small camera and fiberoptic light, to visualize the inside of the lungs. This is passed through the windpipe from the mouth or nose, while the patient is under local anesthesia. A small piece of tissue is then extracted using forceps that also are passed through the airways.

Open lung biopsy

An open lung biopsy is carried out while the patient is under general anesthesia. It involves the surgeon making an incision on one side of the chest to access the lung tissue. The ribs are gently parted, and the surgeon may insert a viewing scope to examine the lungs before removing a small piece of tissue.The surgeon then will close the opening with sutures.

Needle biopsy

A lung needle biopsy is normally carried out while the patient is under local anesthesia and is much less invasive than an open biopsy. A small cut is made on the side of the chest so that a biopsy needle can be inserted into the affected lung tissue. The biopsy needle is normally around the width of a paper clip and hollow so that a small tissue sample can be acquired.

A needle biopsy is often guided by a CT scan, for the doctor to accurately identify the tissues to be removed with the needle.

Video-assisted thoracoscopic surgery (VATS)

A thoracoscopic biopsy, or video-assisted thoracoscopic surgery (VATS), involves several small incisions being made while the patient is under general anesthesia so that a thoracoscope can be inserted through the chest wall. A thoracoscope is a tube with a light, that helps the surgeon see inside the chest cavity, either through an eyepiece or via an attached video camera. Another incision also may be needed to insert surgical instruments to remove lung tissue.

Risks associated with lung biopsy

There is a small risk that the patient may experience complications such as an infection, pneumonia, excessive blood loss (hemorrhage), or air leak from the lungs. In extreme cases, an air leak can lead to a collapsed lung (pneumothorax) when the leaked air becomes trapped between the lung and chest wall.

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