Questions to Ask - Lung Biopsy

[DRock]

Hi Everyone,

Tuesday I have my first appointment with the surgeon to go over my chest CT.

If a biopsy is recommended, what questions should I think about asking?

Thank you,

Carrie

[Tom Galli]

Carrie,

My first question would be about the method the surgeon intends to use to obtain a biopsy. There are three (typically): aspirational needle; bronchoscopy, and surgical procedure. They are listed in ascending order of recovery trauma so I would prefer a needle biopsy if the nodule or tumor is large enough to get a reliable sample. A needle biopsy in the US is often performed by a interventional radiologist using a local anesthetic. Mine was a 30-minute procedure, but it failed to obtain enough material to reliably diagnose. My second biopsy attempt was performed by a pulmonologist using a flexible bronchoscope. I was anesthetized but not as severe as general anesthesia. And, this attempt also failed. My first successful biopsy was a combination procedure performed by my thoracic surgeon. He used a rigid bronchoscope to obtain a sample of the large tumor in my main stem bronchus and removed and biopsied lymph nodes around my lungs by making an incision at the base of my throat. I was under general anesthesia but was discharged when I recovered from anesthesia several hours after the procedure. This biopsy rendered my diagnosis: non small cell squamous cell lung cancer.

The second question is about the type of biopsy to be performed on recovered tissue. The way lung cancer is diagnosed is by a pathologist examination of tissue under a microscope. This is called a histology procedure and can be performed quickly. It was the only method available almost 19 years ago when I was diagnosed. Now there are follow-on laboratory analysis to check for the presence of mutations or markers to determine suitability for Targeted Therapy and or Immunotherapy. In this US, obtaining this form of analysis can involved a covered-procedure battle with one's medical insurance provider. I wouldn't know Canada's National Health System's view on follow-on biopsies. But, I personally believe this is important enough to engage to the point of demanding. Targeted Treatment and Immunotherapy have become first-line (first treatment) methods and can be very effective, and in the case of Immunotherapy, curative.

Again I don't know how one gets to interact with various specialities in your health system but if it were me, I'd be seeing a medical oncologist and a radiation oncologist shortly after my biopsy so I'd ask the surgeon who to recommend.

But the most important question to ask is about the possibility of surgery as a treatment method. I'm trying to recall your history and believe you told us you have 2 spiculated nodules in a single lobe of the lung and lymph node involvement. Depending on the extent of lymph node involvement, you might have the nodules or the entire lobe and affected lymph nodes removed as curative care. Moreover, you might be offered follow-on chemotherapy after surgery and if offered, I'd take it. I know so many early stage survivors treated surgically who've had recurrences after a "curative" surgical procedure. High recurrence probability is what make our disease so dangerous. So, I'd throw everything including the "kitchen sink" at it to dramatically improve the "one and done" treatment probability.

Stay the course.

Tom

 

[DRock]

Hi Tom,

Thank you so much for the information.  

I have three nodules, two in the right upper lung, one in the middle lung.  Then it just says multiple lymph nodes in the pre vascular space.

I wasn’t exactly sure what the surgeon’s role is as it relates to lung cancer.  Sounds like you went through quite a lot before you received your diagnosis.

Congrats on 19 years!

Carrie