Lung Diagnostic Tests & Surgery

Diagnostic Tests

To help your doctor evaluate your lungs and diagnose your condition, a variety of tests may be performed. You may have already had some of these tests, and others may be scheduled before surgery. The information gathered during these tests helps determine the best treatment for your condition.

Imaging tests

Imaging tests, which take pictures of your lungs, can detect problems such as a mass, an infection, or air in the pleural space. However, they can’t tell the doctor if a lung mass is benign (non-cancerous) or malignant (cancerous). A biopsy of tissue or the mass is necessary to determine if cancer is present.

Visualization and biopsy tests

Visualization tests let your doctor look directly inside your lungs and at the area around your lungs. A biopsy also may be performed. A biopsy is when a sample of lung cells or tissue is removed and examined under a microscope to help diagnose your condition.

• Mediastinoscopy
  A mediastinoscopy is a surgical procedure where a tube is inserted through a small incision above the breastbone into the mediastinum – the area in the chest between the lungs. The surgeon can examine the lymph nodes and a biopsy can be done.
• Bronchoscopy
  A bronchoscopy is a procedure where a thin tube with a light on the end is placed through your mouth or nose to examine the breathing passages or airways at the entrance to your lungs. Medicine is used to help you relax during the procedure. During this test, the pulmonologist removes a small amount of tissue from the surface of the airways so that it can be examined.
• Endobronchial Ultrasound (EBUS)
  An endobronchial ultrasound is a newer technique during which the pulmonologist uses a special ultrasound probe to send sound waves through the walls of your airways into the surrounding areas, including the lungs and mediastinum. If abnormal areas are seen on the ultrasound, the pulmonologist will take a sample of tissue using a small needle.
• Image-Guided Needle Biopsy
  A specially trained radiologist will remove lung tissue with a thin needle placed through the chest wall. A CT scan is used to locate exactly where the needle should be inserted. After the biopsy, a chest X-ray will be taken to make sure that there is no air leaking from the lung.
• Pulmonary Function Tests (PFTs) Pulmonary function tests measure how well your lungs are working. This information is needed if surgery is a treatment option. Pulmonary function tests include:
  • Spirometry, which measures how much air your lungs can hold.
  • Lung volume tests, which measure how much air is left in your lungs after you exhale.
  • Lung diffusion tests and pulse oximetry, which measures how much oxygen is passed from your lungs to your blood.
  • Quantitative ventilation/perfusion (VQ) scan, which helps determine how much of the lung can be safely removed.

Surgical Methods

Lung surgery is often done to get a closer look at the inside of the lungs and help treat lung problems. If a mass is found in the lung, surgery can help determine the cause of the mass. If needed, the mass also may be removed. Lung surgery also may be done for other conditions such as a collapsed lung or fluid around the lung. Lung surgery involves entering the chest wall to get to the lung. This is done either by thoracoscopy or thoracotomy. Your surgeon will choose the method that’s best for your condition.

Thoracoscopy or Video-Assisted Thoracic Surgery (VATS)

For a VATS procedure, two to four small incisions are made on the chest. Each incision is about one-half to one inch long. The surgeon places a thin tube with a video camera and light source, called a thorascope, in one incision. This allows the surgeon look into the chest cavity. The lung tissue is cut away and placed in a small bag and then removed through a small incision.

Thoracotomy

For a thoracotomy, a larger incision is used, which allows the surgeon to see the lungs directly. The surgeon makes an incision, about five to six inches long, below your shoulder blade. A rib is partially cut to allow the surgeon to spread the rib cage to expose the lungs. The lung to be operated on is deflated, while a breathing tube helps your other lung continue working. The deflated lung is examined and any needed procedure is performed, including removing part or all of the lung. In some cases, nearby lymph nodes may be removed.

Robotic-assisted lung lobectomy

The da Vinci surgical system allows the surgeon to remove a lobe of the lung through several small incisions rather than a larger incision and without spreading the ribs. The da Vinci is a computer-directed robot that the surgeon operates by sitting at a remote console and using joystick-like controls to maneuver its robotic arms. Recovery is shorter and there is less pain.

Lung mass or nodule

If a mass or nodule has been found in the lung, a biopsy or sample of the mass can be removed and examined to determine whether it is benign (non-cancerous) or malignant (cancerous). In addition, lymph nodes can be removed and examined to check whether the cancer has spread to other areas of the body. If the mass needs to be removed, its size, location and whether it has spread to other areas, as well as your general health will determine how much of the surrounding lung also needs to be removed. Removal of part or all of a lung is called lung resection.

Here are the different options for a lung resection:

Surgery biopsy results

The samples taken during surgery will be studied under a microscope by a doctor with special training called a pathologist. The pathologist will send your doctor a pathology report that gives a diagnosis for the samples taken. Information in this report will be used to help manage your care.

These results typically take three to four working days to be finalized. Your oncology nurse navigator will call you with the results if they are not available before you leave the hospital.