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Lung Biopsies Carry Risks

Article date: November 9, 2011

By Stacy Simon

Authors of a recent study say patients need to be more aware of the risks associated with low-dose computed tomography (CT) lung scans. These tests can be done for a number of reasons, but in recent years some doctors have begun using them to screen for lung cancer in people who are at increased risk, such as heavy smokers. The hope is to find lung cancers early, when they are easier to treat.

Lung Scans and Lung Biopsies

A CT lung scan is an imaging test in which many x-rays are taken from different angles of the chest. These images are combined by a computer to make detailed cross-sectional pictures of the lungs. If the scan reveals a suspicious spot or nodule, the doctor and patient must then decide whether to wait several months and repeat the test or to do more invasive tests, such as getting a biopsy of the nodule to find out if it’s cancer.

Nodules are detected in as many as 25% of patients who have a CT scan, according to the study authors. Most of them turn out to be benign (not cancer), but doctors often can't tell for sure without getting a biopsy of the lung tissue. The problem is that lung biopsies themselves can be invasive, requiring placement of a long, hollow needle through the chest wall and into the lung to get a sample of the nodule. (In some cases, even more invasive types of biopsies may be needed.) The procedure can have serious risks, including partial lung collapse and bleeding.

Researchers from Boston University School of Medicine set out to better define the risks from needle biopsies. They reviewed data from 2006 on more than 15,000 people who underwent a lung biopsy. Partial lung collapse occurred in 15% of patients. In about 7% of patients the problem was serious enough to require a chest tube to help relieve it, which led to a hospital stay of 2 to 5 days. Those patients were also more likely to develop respiratory failure that required a breathing machine. Bleeding occurred in only 1% of patients, with about 1 out of 5 of them requiring a blood transfusion. Complications were more common in patients ages 60 to 69, smokers, and patients with chronic obstructive pulmonary disease (COPD).

The study was published in the Aug. 2, 2011 issue of Annals of Internal Medicine.

The National Lung Screening Trial

The study’s authors say public and physician enthusiasm for lung cancer screening was renewed when the National Cancer Institute began reporting results from the National Lung Screening Trial (NLST). The trial, which compared chest CT with traditional x-rays, found a reduction of 20% in lung cancer deaths in the CT group.

American Cancer Society Chief Medical Officer Otis Brawley, MD, says the National Lung Screening Trial was one of the best done because it clearly shows both the potential benefit and harm of CT lung scans. He says, “A screening test is always a double-edged sword. The good part is when it saves lives. The bad part has to do with false positives and harm.”

The NLST showed that for 26,000 people who were screened with CT scans once a year for 3 years, 88 were saved from dying of lung cancer, but 16 died from complications of an invasive procedure after the scan. Dr. Brawley says real-world results would probably be worse, because procedures included in the trial were done only in 37 of the best hospitals in the US.

Dr. Brawley says people at high risk for lung cancer, including heavy smokers, are likely to get the greatest benefit from CT lung screening. People who are at low or intermediate risk for lung cancer are taking the same risks when they get screened, but may not benefit as much.

Interim Guidance

The American Cancer Society and other groups are reviewing the results of the NLST, as well as other studies, to develop guidelines for lung cancer screening. Currently, most major professional organizations, including the American Cancer Society, are not yet recommending routine lung cancer screening. However, some people at higher risk may still wish to talk to their doctors about whether lung cancer screening is right for them.

Until the experts at the American Cancer Society develop full cancer screening guidelines, they have created the American Cancer Society Interim Guidance on Lung Cancer Screening regarding the use of low-dose CT scans for the early detection of lung cancer.

Even with the promising results from the NLST, people who are current smokers should realize that the best way to lower their risks for lung cancer is to stop smoking. For help quitting smoking, see our Guide to Quitting Smoking or call the American Cancer Society at 1-800-227-2345.

Reviewed by: Members of the ACS Medical Content Staff

ACS News Center stories are provided as a source of cancer-related news and are not intended to be used as press releases.

Citations: Population-Based Risk for Complications After Transthoracic Needle Lung Biopsy of a Pulmonary Nodule: An Analysis of Discharge Records. Published in the Aug. 2, 2011 issue of Annals of Internal Medicine (Vol. 155, No. 3). First author: Renda Soylemez Wiener, MD, MPH, The Pulmonary Center, Boston University School of Medicine, Boston, Mass.

National Trends in Use of Computed Tomography in the Emergency Department. Published online ahead of print publication in Annals of Emergency Medicine. First author: Keith E. Kocher, MD, MPH, Department of Emergency Medicine, University of Michigan, Ann Arbor, Mich.

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