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

Posted by covington @covington, Oct 17, 2023

I have a 1.3 cm nodule in upper left lobe. Bronchoscopy confirmed the lymph node was negative. But, too much bleeding to get a sample of the nodule.

The doctor is giving the choice - Take an IR guided, external needle biopsy. Or, go for full-on surgery to remove the nodule and test it on the spot to determine if malignant lung cancer (remove entire lobe), or metastasized from existing kindey cancer 1.3 cm, or negative.

Could I get advice on which route to choose?

Interested in more discussions like this? Go to the Lung Cancer Support Group.

bpb | @bpb | Oct 19, 2023

Hi,

You want a medical oncologist as well as the surgeon on your team. That doctor has a good overview of all the options available. Does this center have a tumor board? The tumor board has doctors from all specialties involved in cancer care. They look at the scans and brainstorm as to the best options. Ask if the tumor board can review your case.

As I recently learned, the needle biopsy doesn't give information on staging. The other option would give that info more quickly. I don't remember if your bronchoscopy showed any activity on lymph nodes? That might be another reason to go with the option of the wedge resection - info on whether the lymph nodes are involved.

I hope this helps. Sending warm healing energy.
BPB

REPLY
pb50 | @pb50 | Oct 19, 2023
In reply to @covington "To help to clarify - my thoracic surgeon, who works in the cancer center and specializes..." + (show)
@covington

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?

Jump to this post

Sounds about right to me - or just a simple request along the lines of … since I’m a novice to cancer, I’d like to also get input from an oncologist - could you make a referral?

REPLY
pb50 | @pb50 | Oct 19, 2023
In reply to @covington "Thanks, Everyone. I greatly appreciate all of the support and information. It's kinda difficult to get..." + (show)
@covington

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.

Jump to this post

I’m with you now. You sound confident in your instincts and it sounds as if you will have input from an oncologist tomorrow, which has been my chief recommendation to your path. It all makes sense to me now. You have appropriate input you have confidence in so continue your fact gathering and know that all of us are sending good Juju your way!!

And I agree it is really difficult to figure out which post came before what 🙂

REPLY
Mentor
Lisa, Volunteer Mentor | @lls8000 | Oct 19, 2023
In reply to @covington "Thanks, Everyone. I greatly appreciate all of the support and information. It's kinda difficult to get..." + (show)
@covington

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.

Jump to this post

@covington, I'm happy that the bronchoscopy doctor was able to provide some additional insight and context of the risks with the proposed procedures. Doing the least invasive step first seems to be a good fit for you. Best of luck with the appointment with the oncologist too!

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