Dr. Ullas Batra
Consultant Radiologist
Rajeev Gandhi Cancer Hospital. New Delhi
“…….Unaware of the truth, she lay burrowed from the exam,
Beneath her skin, in her lung lives a large tumor,
By the time the needle bubbled into her needle and vein…
And she felt her beauty had departed….”
Lung cancer incidence has been on the rise. A disease once considered a “men’s disease”  has now shifted sides. Many women are diagnosed with advanced-stage disease, although almost 60% are expected to have an actionable target. By an actionable target, I mean a genetic change that is present on the tumor can be hit by drugs specifically made for them. However, just like other diseases and social stigmas which exist within the unseen barriers of our society, there are several myths, taboos, and suchlike which not only prevent optimal treatment, but also optimal diagnostics.
Everyone fears when their doctor says “ this needs a biopsy”. There is a general myth that biopsy is a mini operation. Through this brief article what I intend to do as a practicing thoracic oncologist, is to bust these myths and taboos associated with lung cancer biopsy
MYTH #1 : Biopsy is a mini operation and I can die..
TRUTH: NO. A biopsy is just to see what type of cancer it is. It is not an operation that involves removing an organ or a tumor in too. There are different types of lung cancer biopsy and newer techniques of interventional radiology now allow image-guided biopsies that are minimally invasive. OBVIOUSLY, You cannot die!!! The maximum you can suffer from is a little bit of bleeding and pain. Your doctor takes care to minimize those as well.
MYTH #2: Biopsy will cause my cancer to spread..
TRUTH: While there are a few case reports, which suggested that this might occur in rare cases.  This possibility can be effectively avoided by taking all the necessary steps to prevent the spread of cancer cells during the sample collection. Newer image modulated technologies of biopsy ensure minimal risks and advances in training and technical expertise of the interventional radiologist ensure the same.
MYTH #3 Biopsy can leave behind scars and make me ugly
TRUTH: Yet again. The answer is NO!. These were problems of the earlier days when technical expertise and technological advancements were limited.
MYTH #4: Biopsy always needs hospitalization
TRUTH: Most biopsies are minor procedures and require local anesthesia, hence can be performed as an outpatient procedure
MYTH #5: By biopsying my lung, I may die as the lung is a hollow organ and hence it may collapse
TRUTH: Yes, there are very few instances of pneumothorax complications, however, these are extremely rare. In my routine practice, I am yet to witness such a case. So you can imagine the rarity.
MYTH #6: My doctor says my cancer has progressed, and my lungs need a biopsy again. Is he trying to make money?
TRUTH: Again the answer is NO!. If you have not responded to the ongoing line of treatment and have developed new tumors or your existing tumor has become bigger, your doctor just wants to know if there is a new change which is happening/ a new genetic alteration that may have happened which can hinder treatment outcomes
MYTH #7: We hear so much about blood biopsy, then why does my doctor insist on sticking a needle in my lung?
TRUTH: Blood is blood. You cannot say that a tomato is a soft apple, just because it’s red. Your tumor is in the lung. Until and unless the doctor knows what lies in the lung, how will he know what to treat?
Some facts simplified.
A biopsy is the gold standard diagnostic test, available, and all national international recommendations for treatment of lung cancer mandate a tissue biopsy followed by a battery of tests to arrive at a conclusive diagnosis to begin treatment. Deciding what treatment, rests on the biopsy results. A lot depends on which type of lung biopsy your doctor recommends.
In routine cases, an endo-bronchial biopsy under ultrasound guidance may be performed. Your doctor will insert a flexible tube that’s about as wide as a pen into your mouth or nose, and from there into your lungs. A light and camera will help guide his tools that take cells from your lung out through the tube. You’ll be awake while this is going on, but you may be administered some sedation to relax. Others may prefer a biopsy under CT scan guidance to spot the exact area, incase the endo-bronchial procedure is not feasible.
The cells which are taken out are sent to the laboratory, and typically in 72-96 hours we know if there is a malignancy or not. The same sample is subjected to molecular testing to look for molecular alterations, in order to decide treatment regimen. The same biopsy may also be subjected to tests to decide if you are a fit candidate for immunotherapy versus targeted therapy or chemotherapy.
Concluding Remarks
A biopsy is a must to diagnose lung cancer. The tissue is the gold standard. Liquid biopsy using blood has emerged, but without available tissue diagnosis, interpreting the same may not prove scientifically correct. Talk to your doctor about your concerns openly, and consent for a biopsy if asked. It’s not dangerous! And it will definitely not make you ugly, it may give you warrior scars since if you are fighting cancer, you’re a warrior!
This information is for general guidance and reflects the opinions and experience of the author. It is not intended to replace specialist consultation or provide treatment advice for specific cases

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