Bronchoscopy
Mediastinoscopy
Thoracoscopy
Fine-needle aspiration
Bronchoscopy
Bronchoscopy allows your pulmonologist (lung specialist) to look into your airways and lungs. Bronchoscopy is used to evaluate and treat growths in the airway, diagnose and determine the extent of lung cancer, control bleeding, or remove objects blocking the airway. It can also be used to treat airway problems such as bleeding and obstruction.
There are two types of bronchoscopy: flexible or rigid. Flexible bronchoscopy is used whenever possible because it is more comfortable and does not require general anesthesia.
You may need to remove dentures, empty your bladder, and put on a hospital gown. Your heart rate, blood pressure, and oxygen level will be monitored during the procedure. You will be have an IV line (intra-venous; into a vein) placed in your arm, and receive medication to sedate (relax) you.
Prior to the placing the scope through your nose, an anesthetic ointment is given in the nose to numb your nasal passages to make you more comfortable. A local anesthetic in the form of a spray is given in your nose and mouth; this will numb your throat and reduce your gag reflex. More anesthetic is sprayed through the scope to numb your vocal cords. You may be asked to make a high-pitched sound while the scope is passed through the vocal cords.
You will not feel pain during the procedure, but you may feel pressure, or want to gag or cough. Therefore, most patients are given a mild sedative during the procedure; this will keep you comfortable even if you are not completely asleep. You may not eat or drink for about 2 hours, or until you can swallow without choking.
At 4-6 hours after the bronchoscopy, it is not uncommon to have shaking chills; this usually responds quickly to acetaminophen (Tylenol; 650 mg). A small amount of blood in your sputum is not uncommon after a biopsy. The following day you may feel tired, and have a low-grade fever, general muscle aches, or a sore throat. If you have any concerns about symptoms after a bronchoscopy, please call a physician at (631) 444-2981 during business hours or (631) 689-8333 on off-hours.
Results of a biopsy (tissue sample taken for analysis) may take 2-4 days to be available. As with most biopsies, a negative result does not prove that you don't have cancer. There is always the chance of a "false-negative" result-a test result that is erroneously classified in a negative category because of imperfect testing methods or procedures.
Please click here for bronchoscopy instructions.
Mediastinoscopy
Sometimes a biopsy of the chest's lymph nodes (pea-sized "glands" that filter impurities from the body) is needed to stage or diagnose lung cancer. This test is performed by a surgeon, who will make a small incision just above your breastbone, and slide a scope down next to your windpipe to remove some of these lymph nodes. The biopsy is performed under general anesthesia. It is done as an outpatient procedure. You will need to have pre-operative testing.
The results of the biopsy will be available in about 4-5 business days. Some people may complain of a sore throat. This will often resolve within a few weeks. If is does not, let your surgeon know. You will have a dressing over the incision, which can be removed after 24 hours, and then you may shower. There will also be small strips across the incision, which will fall off on their own within a few days or can be removed after a week.
Thoracoscopy
Thoracoscopy is a procedure that can be performed by a surgeon to look in your chest. This can be performed to take a biopsy of your lung, to look at the pleura (the lining of the outside of your lung), to remove fluid that can collect in the space between the lung and chest wall, to remove a nodule, or to remove part of the lung.
The surgeon will make a minimum of three small incisions on the side of your chest between the ribs. A scope is used to see inside of your chest. The surgeon is able to insert the surgical tools through the other two incisions, and perform the necessary procedure this way.
This operation is performed under general anesthesia and requires a stay in the hospital. You will need to have pre-operative testing.
After the surgery you will have a drain, called a chest tube, placed in your chest. The tube helps to drain blood, fluid, and air from around the lung. It is put in the chest cavity through the skin, and is attached to a collection system. This tube will usually remain in for about a day or two after surgery. Sometimes it will have to stay in longer as necessary. Once the tube is removed, most people are able to go home that day or the following day.
Please click here for pre-operative instructions, "Preparing for Lung Surgery."
Please click here for post-operative instructions, "Do's and Don'ts After Surgery."
Fine-needle aspiration
Fine-needle aspiration is the name of the process of obtaining a sample of cells and bits of tissue for examination by applying suction through a thin, hollow needle attached to a syringe. The sample of cells and bits of tissue is called a biopsy.
Needle biopsies can be obtained through the chest wall into the lung. Lesions (abnormalities) that can be evaluated in this way are those that are large enough and on the outside of the lung. Not every lung lesion can be accessed with a needle.
The skin is cleaned and numbed with anesthesia called lidocaine that causes loss of sensation to prevent pain. The needle is placed under radiologic imaging (usually fluoroscopy or CT scanning) to help guide the needle into the lesion. There should be minimal pain during the procedure, as most of the pain fibers can be numbed with anesthesia. Some patients cough up some blood, but this is uncommon and the amount of bleeding is usually very small.
Since the needle is puncturing the lung, the lung may collapse. The likelihood of lung collapse depends on how big the lesion is, the amount of emphysema (abnormal increase in the size of air spaces in the lung) near the lesion, and how deep the lesion is from the chest wall. Many patients with a lung collapse have only some mild chest discomfort and mild shortness of breath; if so, there is no treatment necessary.
If the lung collapses further, a small tube may need to be inserted to re-expand the lung until the hole stops leaking. If a tube is placed, you may require admission into the hospital for 1-2 days. The physician doing the biopsy will explain this to you prior to the procedure. Because of the risk of lung collapse, you will have x-rays performed after the biopsy and may require observation in the hospital for 3-4 hours after the biopsy.
Results of a biopsy may take 2-4 days to be available. The yield of needle biopsy is usually very high, but a negative result does not prove that you don't have cancer. There is always the chance of a "false-negative" result-a test result that is erroneously classified in a negative category because of imperfect testing methods or procedures.
Please click here for instructions.