Sputum Cytology
This is the analysis of cells from the sputum (phlegm) in your lungs, by a medical pathologist. Sometimes a diagnosis can be determined using this test. The sputum is collected in a cup if the patient is able to cough it up. Sometimes a special breathing treatment is given to help the person cough up the sputum.

Bronchoscopy
A lighted tube (bronchoscope) is placed into the windpipe of the patient in the operating room. This is done with medicine to put you to sleep (anesthesia sedation). The physician is able to look through the bronchoscope into the airways of the lungs to see any abnormal areas. The physician can then identify the area to perform a biopsy. This technique also provides information whether the tumor can be removed by surgery. It works best for tumors near the central windpipes (airways). It is an outpatient procedure and you will go home the same day. The photo on the right shows a tumor blocking the windpipe.

Needle Aspiration/Needle Biopsy
A needle is inserted into the tumor or area in question and cells are removed. Usually the procedure is done under the guidance of a CT scan or an Ultrasound in order to accurately hit the target. These are both done as an outpatient and you will go home the same day.

CT scan guided biopsy
In the radiology department, the patient is placed into the CT scan machine and using x-ray guidance, the area in question is biopsied using a thin needle placed through skin. The area is numbed (anesthetized) first. It works best for tumors near the edge of the lung. The photo on the right shows a CT scan.

Ultrasound guided biopsy
In the radiology department, the radiologist uses an ultrasound “wand” to locate the area in question. The wand has lubricant or jelly applied which helps the image to appear on the screen. The area is numbed (anesthetized) and a needle is placed into the area in question.

EUS (Endoscopic Ultrasound) or EBUS (Endobronchial Ultrasound)
Specially designed ultrasound probes attached to small tubes that are placed in the swallowing tube or windpipe allow biopsy of certain deep lymph nodes that formerly would require a surgical incision to access.

Thoracentesis
Some tumors cause a build up of fluid around the lung called a pleural effusion. A needle can be inserted into this space to drain the fluid and obtain cells for analysis. Sometimes ultrasound can guide this needle placement.

Surgery
Sometimes, less invasive methods, such as a needle biopsy, fail to confirm the cause of a lump or are not appropriate becuase they can't prove that the lump is benign. There are several methods that a lung surgeon may use to obtain the biopsy, including a mediastinoscopy, mediastinotomy or thoracoscopy. Sometimes the lung surgeon will perform a larger operation (thoracotomy) when the risk of the lump being cancer is high, the risk of the operation is low, and the potential to cure the cancer is high. In this case, part of the lung is removed entirely.