Bronch biopsy didn't work. Should I do a IR biopsy? Or, surgery?

I’d be interested in whether they might entertain a wedge resection if lymph nodes are negative and margins are clean. I had a 1.4cm mass in left lower lobe and they first did a wedge section containing the mass and sent to pathology who confirmed it was malignant. So he then took the entire lower left lobe. Only a week later did I get the rest of the path report - all lymph nodes negative and all margins clean. I felt then that perhaps the lobectomy was overkill and my recovery might have been easier if he has stopped with the wedge resection.

That said, my mass was so close to the outside edge of my lung he could easily access it etc - that may not be the case with your mass on an upper lobe. But I would surely ask if wedge resection is an option.

All that to say I’d ask if it will influence his action if it is malignant. Because of my experience I’d be inclined to seek the guided biopsy.

Hi @covington, welcome to Mayo Connect. These decisions can be so difficult, I'm sorry to hear that you are facing this decision. Trust your instincts, give yourself grace, and recognize that you actually know more than a patient with no cancer experience. It's always hard to give advice over an on-line forum, keep that in mind. None of us really know your history or level of health and strength. I know I'm adding more questions than answers. It's such a personal decision.
How do you feel about your current team of doctors? Confident? Have you been speaking with a surgeon or your established oncologist? A pulmonologist may offer a unique perspective, as they may be able to share some info on the risks and the impact of living without a lobe.
I'm assuming that the IR (interventional radiologist) would perform a needle core biopsy. It sounds like the bleeding from the bronchoscopy was unexpected, do they know what caused that? Might they have the same difficulties with a needle biopsy?

As ever, Lisa’s advice is so skilled and considerate of much more than a personal experience/bias.

Thank you so much.

Yes. As I understand it, a wedge resection(?) is an option since the lymph nodes were clean.

I was given these two options through a nurse - basically, what do you want to do:

- external IR directed needle biopsy (issue being that there could be similar problems seeing the area as I had with the bronchoscopy).

- Wedge resection. And if, during that operation, a lobectomy if on-the-spot testing says it's needed.

I have zero medical background, and I find it odd that major decision is left to me. I'd rather the experts dictate which direction to take.

So, I'm here asking for you, kind people, opinions.

Thanks, much.

Thanks. Yes, I have bleeding issues with a blood thinner and a Lovinox bridge over the week of surgery so it can be more controlled in the operating room. But, still too much bleeding, I guess.

I do not know how to judge the competence of my thoracic team. They seem great, and have some good reviews, but I have no idea if that qualifies them. But I have faith.

I do plan on having higher than normal risk of detecting with a needle biopsy. But, it sure seems like the logical step, versus going all at it.

I understand. But none in this group are doctors and even if they were they aren’t familiar enough with the important variables in your case that would need to be considered before offering an opinion. As far as method to get a biopsy, Have you considered asking your doc what he would advise someone in his family to do if they were in your circumstance?

Think about what you want to understand now and later. And perhaps get an oncologist opinion? Maybe an oncologist could provide insight into why a lobectomy is necessary with a small mass and clean lymph nodes - so you can better understand the risk.

I didn’t get that oncologist second opinion and I regret that. A girl can’t have too much intel! 🙂

I've had the needle biopsy, and I had bleeding in the lung at the moment the doctor hit the cyst, but I'm guessing your doctor knows that possibility. Also, my cyst was more of a balloon surrounding a void. A solid cyst might not induce the bleeding I experienced.

Personally, I strongly suggest you find an Oncologist for a second opinion. Putting myself in your shoes, I would be put off by the fact that my doctor is asking me to make this decision. And, back to being me, I would look for the best Oncologist I could find.

I also like pb50's comment about asking what the doctor would advise a member of their family, for example, their parent or child.

Sending you much eeeeeease and please keep us informed!

@covington, I hope you are able to take comfort in the responses here. We all seem to agree that the decision that you are faced with is unreasonable without adequate information and knowledge to make that decision. I hope you are able to get additional help and advice from a doctor that can review your case in its entirety.

Thanks, Everyone. I greatly appreciate all of the support and information.

It's kinda difficult to get the hang of how and where these replies are posted, so I'll do my best.

After meeting with the doc who did the bronchoscopy, I am now confident in the cancer team - as I had done as suggested here and got his off-the-record opinion of the cancer team, and he said he would absolutely recommend them to his own brother should he be in my situation. That, coupled with the fact that my insurance is very narrow and my options would be limited. This is likely the strongest cancer center within 200 miles in my state.

As for the process itself - A needle biopsy would be guided by IR. The Bronch Doc said that the bleeding issues I had would NOT be a factor in an IR guided procedure, because they would be navigating directly to the mass, and not have to worry about visual navigation like he did. The only major complication to worry about with the needle biopsy would be an "air leak" in the lung afterwards, which is not minimal.

To me, it now makes sense to go ahead with the needle biopsy. Here's why: We meet the oncologist Friday for her opinion. But, if things don't change, it only makes sense to do a minimally invasive, fact gathering mission to determine the content of the mass.

If the mass is benign, then wait for more information over time. If it is malignant, then go for the wedge resection (correct term?). During the wedge removal, they would view on the spot if it was all removed, or do a lobeectomy on the spot.

To me, it does not now make sense to jump over the needle discovery portion and dive head first into things that come with much bigger potential issues.

Thanks again for all the help. Please let me know if you feel this information makes sense or not.

To help to clarify - my thoracic surgeon, who works in the cancer center and specializes in things like lobectomies for =cancer patients.

I am learning, I think, that this does not make her an oncologist.

So, my meeting tomorrow, with her, I will be introducing the question of "How do we also get the opinion of her respected oncology colleague for the proposed procedures?"

Does that sound right to everyone?