Distant metastasis is the spread of cancerous cells to areas of the body other than the original tumor site. A biopsy can identify features of the abnormal cells and determine whether they are cancerous or noncancerous. Additionally, a biopsy may help in evaluating whether an existing cancer has evolved or progressed since the original diagnosis.
Biopsy methods vary depending on what part of the body is being assessed. The information provided below explores the types of biopsies that can be taken from the lung & chest, liver, and bone. The degree of invasiveness differs amongst biopsy methods. Typically, more invasive procedures are carried out if the minimally invasive options are unable to provide a definitive diagnosis.
Ways to Perform a Lung & Chest Biopsy
This is the removal of cells or tissues from either the lungs or lymph nodes in the chest. There are several ways to perform a lung or thoracic (chest) biopsy.
Sputum Cytology
This involves spitting up mucus brought up from the lungs and analyzing the cells within it. This is the easiest method for patients, but it has the lowest chance of achieving a correct diagnosis.
Transthoracic Image-guided Needle Biopsy
This biopsy is done with a needle inserted through the skin of the chest. An imaging method, such as CT scan, fluoroscopy or ultrasound, can be used to guide the needle into the area of concern prior to taking a biopsy. This has a high yield, but it does carry a higher risk of trapping air around the lungs than biopsies done from the inside.
Endobronchial Lung Biopsies
A special, flexible camera is placed through the mouth and into the lungs to take images of the lesion and obtain samples that need further analysis. A few different methods of endobronchial lung biopsies exist. Some methods involve removing a piece of the tissue (biopsy), whereas others remove only a few cells (transbronchial needle aspiration, brush biopsy, bronchoalveolar lavage). For patient comfort, sedation and a numbing medicine are used.
Video-assisted Thoracoscopic Surgery (VATS) or Mediastinoscopy with Biopsy
In this technique, a camera is inserted through a few small incisions in the chest or upper neck. This technique requires general anesthesia in an operating room. If less invasive techniques do not find the diagnosis but the suspicion for cancer is high, the doctor might recommend this technique. As in an open surgical biopsy, if there is only a single area of concern, this technique (particularly VATS) can remove the entire lesion, thereby finding a diagnosis and removing metastasis at the same time.
Open Surgical Biopsy (Thoracotomy)
Using general anesthesia and opening the chest to remove the part of the lung with the suspicious lesion is the best approach for reaching a definitive diagnosis. However, it is the most invasive way to biopsy a suspicious lesion with the longest recovery. This method is reserved for a single isolated lesion in the lung that is highly suspicious for cancer. Not only can it find a diagnosis, but if it is the only lesion, it can also remove metastasis at the same time.
Ways to Perform a Liver Biopsy
This is the removal of cells or tissue from a suspicious lesion in the liver. There are several ways to perform a liver biopsy.
Transabdominal (or Percutaneous)
This method uses a small needle placed through the skin. In situations where the doctor is looking to get cells from a specific part of the liver (as in liver metastases), an ultrasound or low-dose CT scan will usually be used to confirm that the needle enters the suspicious area before removing the cells. The patient must lie still on the side of his or her body with the right arm up toward the head. The patient must hold his or her breath for a short amount of time while the biopsy is being done.
Transvenous
In this method, a specialist inserts a catheter, a tiny flexible tube, into the jugular vein and, using fluoroscopy, threads it back through the system of veins into the liver. A small biopsy can then be taken through the catheter and the cells can be examined under a microscope. This is not typically used for cancer diagnosis because it is difficult to get into a specific lesion.
Laparoscopically
This method requires general anesthesia and an operating room. The patient will be put to sleep, and multiple small incisions are made in the abdomen to allow a small camera and a few instruments to be used to perform a biopsy. Once the liver and the suspicious growth are in view, a piece of tissue can be removed and sent for analysis.
Ways to Perform a Bone Biopsy
In this procedure, some cells or a piece of abnormal-appearing bone is removed and analyzed under a microscope. There are 2 ways to do this.
Percutaneous Needle Biopsy
In this method, a tiny needle is placed through the skin (after numbing it) and placed into the bone. This is usually done with the guidance of a CT scan or fluoroscopy to make sure the needle gets into the right place. Cells are then analyzed under a microscope.
Open Biopsy
In this method, the patient will receive some type of anesthesia that will either numb an entire area or put the patient completely to sleep. A small incision is made through the skin, the bone lesion is identified and cells are removed for analysis.
Download This Section
Feel free to download and print this page.
It’s free for personal use and to share with others you think might benefit from the information provided.
