Needle biopsy—this is done with CT-guidance in order to guide the placement of the needle. Fine Needle Aspiration (FNA) uses a slim, hollow needle attached to a syringe to remove some suspicious cells for study. Large needle (core biopsy) uses a larger needle to obtain the needed tissue sample.
Bronchoscopy—a pulmonologist (respiratory disease specialist) uses a fiberoptic, flexible, lighted tube to visually examine the windpipe and lung branches. This may involve using a small, brush-like device to gather cells from the tissues (brushing). A biopsy may also be performed.
Sputum cytology—a sputum (phlegm, spit) sample is taken every morning for three days in a row and examined under a microscope.
Blood counts—a complete blood count (CBC) determines if your blood has the correct amount of various cell types.
Blood chemistry—this test shows abnormalities in certain organs.
Bone marrow biopsy—the back of the hip bone is numbed with local anesthesia and a needle is inserted to remove a bone sample of the bone marrow.
Thoracentesis—if there is a pleural effusion (build up of fluid around the lungs), the skin is numbed and a needle is placed between the ribs to drain the fluid and test it for cancerous cells.
Thoracoscopy—a video camera and a thin, lighted tube are used to view the space between the lungs and the chest wall in order to look for cancer deposits and/or remove sample tissues.
Mediastinoscopy—the patient is put to sleep and a hollow, lighted tube is inserted through a small cut in the neck to the area behind the breastbone (sternum). Special instruments are able to operate through the tube and take tissue samples from the lymph nodes along the windpipe and the major bronchial tube areas.
Mediastinotomy—the patient is put to sleep and the chest cavity is opened by making an incision near the ribs or the breastbone in order to reach lymph nodes that cannot be reached by mediasinoscopy.