CT guided Biopsy (TTNA)

[Julia g]

Hello Everyone, 

I have posted previously about my Lung nodules and surveillance. What is anyone's experience with CT guided needle biopsy? I had a recent follow up with my pulmonologist after my PET/CT. I am being followed at a Lung Nodule Clinic at Stanford (since February 2021) Multiple nodules still present with the most concerning 10 mm in the middle right lobe. I love having options  

So my pulmonologist offered a Needle biopsy with interventional radiology or we go to the next scan in 4 months. Pulmonologist explained there is a 5% -25% chance of collapsed lung with the (TTNA).  I would like to avoid that. My nodule that would be biopsied Is on the periphery and cannot be reached  via bronchoscopy. Any experience would be appreciated. 

~ Julia

 

 

[LouT]

Julia,

Welcome to the forum, sorry you need to be here.  During my diagnostic phase the pulmonologist decided to try a CT Guided Biopsy.  It wasn't a terrible procedure; you lay on a layer of blankets, face down and they numb your back area in preparation for the procedure.  Unfortunately, in my case the doctor administering the test determined that the nodule was so small and hard to get to that he cancelled the rest of the procedure and I had to have a wedge resection instead (followed by a lobectomy when the nodule turned out to be cancerous).  So, I can only bring you 2/3 of the way through the procedure.  Biopsy is the gold standard for determining cancer and the alternative to the CT Guided Biopsy would likely be a wedge resection. where they do surgery and remove a wedge containing the nodule.  If it proves benign they close you all up, if not removal of the lobe would be likely.

Sorry I couldn't confirm having it without a pneumothorax but at least you'll know what your options are if you decide not to get it.  I hope this helps.

Lou

[Julia g]

@LouTThanks for explaining the Needle biopsy. I'm sorry you had to have the Wedge resection. I am going to ask my pulmonologist more questions before I make a decision

[Minh]

Hi Julia,

You have the same problem I had with a small nodule located at peripheral and it's difficult to biopsy with conventional needle or bronchoscopy biopsy. This can be done with robotic bronchoscopy! I just got mine done during the first week of September this year. I also have multiple 5 nodules in both left and right lungs and the largest one is 1.6cm. When I came to MD Anderson about two months ago, they told me the peripheral nodule of 1.6cm in the right lower lobe and near the heart would be difficult to biopsy by needle or conventional bronchoscopy because of potential needle puncture into the heart. After about couple days of technical discussion, they decided to send in a squid like robot tool (robotic bronchoscopy). First they mapped out my lung with CT scan and marked the tumor location. And then slowly sent in a robotic flexible tube that has needle through my mouth. This tube would crawl along the airway until it get close to the tumor and then take sample tissue. They were able to biopsy my nodule with this technique. My cancer turned out to be LPA (lipidec predominant adenocarcinoma). This technology is awesome - no puncture wound, no pain, no worry about collapsed lung, go home in couple of hours with minimal restrictions. So you can ask your team if they have robotic bronchoscopy in their tool box? 

It's kinda like this youtube video below.

Minh

 

 

[Tom Galli]

Minh,

Thank you for telling us about this technology advance. 

Julia,

I do hope your physicians figure a way to biopsy your tumor. I also had the risk of a collapsed lung as a one lung patient. A thoracic surgeon was implanting 5 one mm fiducial markers to allow precision radiation means to target a persistent tumor in my left lung. He used a guided needle method to make the implant.

He told us he was prepared to deal with a lung collapse and convinced us it could be safely dealt with if practitioners were on top of their game. Based on that, I had the 5 implants installed without a collapsed lung. I do hope you close on a biopsy method.

Stay the course.

Tom

[BridgetO]

Interesting videi! Thanks, Minh.

[Julia g]

@MinhThanks so much for the info on the robotic bronchoscopy. I found that the Mayo Clinic and MD Anderson are using that technology. I don't believe Stanford is. But I am going to ask my pulmonologist about it. Minh it sounds like you are in great hands at MD Anderson. 

@Tom GalliThanks for sharing your experience too! 

[Minh]

Hi Julia,

I hope you can get biopsied soon. It took them about two weeks to do mine because they had to get the lung mapping done first prior to sending the robot.
You and I might be in the same boat - multifocal cancer. I am hoping if we can share and compare info. as to how different our treatment plans will be? As of now I elected to have lobectomy instead of radiation. I just want that thing out of me. I feel like a walking alien as long as it still within me.

Thanks,

Minh

[ChiMama]

Hi Julia, I had a CT guided needle biopsy for an 11mm nodule in the middle of my upper left lung. The procedure was relatively easy - it was done under light anesthesia so I was asleep and didn't feel a thing after the IV went in.

After the procedure they have you in the recovery room for several hours to make sure there's no pneumothorax.

Unfortunately I had a small one and ended up being admitted and spending the night in the hospital so they could monitor the collapsed lung. It resolved overnight and I went home the next day.  The site where the needle went in hurt for many weeks afterwards but not to the point of needing pain medication.

Hope that helps!
🐾

[Julia g]

@ChiMamaThanks for sharing your story. Im sorry to hear that you had a collapsed lung tho. 

[alascerca]

Hi there Julia,

I had a CT guided needle biopsy in September. I was TERRIFIED of it, and fretting about it, probably slept less than ever in my life. I was EXTREMELY clear with them that I was terrified, and that I definitely needed very good sedation, as a sense of pain would make me jump from the table. I had concocted myriad scenes of horror...but the all from the staff took my words to heart and my told me that they'd take good care of me.

Well, the whole thing went VERY well, and I DID have the collapsed lung. I was kept overnight, and the chest tube to correct this problem was not really bad at all...it is a HUGE difference from the tubes that I had to have after surgery, which were very painful and much bigger in diameter. This chest tube for the collapsed lung was very thin diameter, and -- just wasn't that bad at all. I felt like such a super-hero once I was through with it; haha. 

Hence -- even with the dreaded complication of the collapsed lung, it really, really was not bad. It  did end up being cancer, so I was operated on the 19th of October -- home recuperating now. Now those tubes...a different picture. However, if staff is good about pain control, even that was endurable.  Bottom line-- we do what we can to avoid pain but we will pay the dear prices to stay healthy...heck...to stay alive!

I believe, firmly, that if you apprise your team of your fear, they will be as gentle and accomodating as professionals were with me. Sending cheers for your progress, and wishes that it all results as easy as was my experience! Sending greetings from the coastal forests of Northern California. ❤️ ~ joana