What it is (overview)

A lung biopsy with imaging guidance is a diagnostic test in which a clinician removes a small tissue sample from the lung so it can be examined under a microscope. The sample is usually taken using a thin needle guided precisely to the target area with medical imaging—most commonly a CT scan (CT-guided lung biopsy) and, in some situations, ultrasound (ultrasound-guided biopsy, often used when the area is close to the chest wall). Imaging guidance helps the clinician reach suspicious spots such as a lung nodule, mass, or area of inflammation while minimizing unnecessary injury to nearby lung tissue.

The tissue sample is sent to a pathology lab. Specialists evaluate the cells to look for signs of lung cancer, infection, inflammation, scarring, or other pulmonary disease. In many cases, additional tests may be performed on the tissue (for example, special stains or cultures for infection, or molecular testing when cancer is suspected).

What the results mean: A biopsy result does not “measure” a number like a blood test; it provides a diagnosis based on what the cells look like. Results may show benign (non-cancerous) findings, malignancy (cancer), infection (such as bacterial, fungal, or tuberculosis-related), inflammation, or sometimes “non-diagnostic” tissue if the sample is too small or does not include the abnormal area. Your clinician combines the biopsy report with your imaging findings, symptoms, and medical history to decide on the next steps (such as treatment, additional testing, or follow-up scans).

When & why it's usually done

This diagnostic test is typically ordered when imaging (such as a chest X-ray or CT scan) shows an abnormality that needs a definite diagnosis. It is often recommended when a doctor needs to determine whether a finding is cancerous, infectious, inflammatory, or related to another lung condition.

Common reasons a clinician may recommend a lung biopsy with imaging guidance include:

Abnormal imaging findings—such as a lung nodule, lung mass, enlarging lesion, or unexplained infiltrate—especially if it persists over time or has features concerning for cancer.

Respiratory symptoms that do not have a clear explanation or do not improve with treatment, such as:

• Persistent cough (with or without coughing up blood)
• Shortness of breath or worsening breathing symptoms
• Unexplained chest pain
• Unexplained weight loss, fatigue, or fevers when lung imaging is abnormal

Risk factors that raise concern for serious disease and may prompt biopsy when a suspicious lesion is present, including:

• Current or former smoking history
• Older age
• Occupational or environmental exposures (e.g., asbestos, silica)
• History of cancer (to evaluate possible spread to the lung)
• Weakened immune system (higher risk of unusual infections)

Why imaging guidance matters: CT scan guidance is especially helpful for small or deep lung nodules because it allows accurate needle placement. Ultrasound guidance may be used when the abnormality is close to the outer edge of the lung and visible with ultrasound, offering real-time guidance without CT radiation.

Common diseases related to it

• Lung cancer (including non-small cell lung cancer and small cell lung cancer)
• Metastatic cancer to the lung (spread from other cancers)
• Benign lung nodules (e.g., hamartoma)
• Pneumonia that does not resolve or has an unusual appearance
• Tuberculosis (TB) and other mycobacterial infections
• Fungal lung infections (e.g., histoplasmosis, coccidioidomycosis, aspergillosis)
• Sarcoidosis
• Interstitial lung disease / pulmonary fibrosis (in select cases)
• Vasculitis affecting the lungs (less common, but may be evaluated)
• Organizing pneumonia and other inflammatory lung conditions

Health goals where it may help

• Clarifying the cause of a lung nodule or abnormal CT scan to protect long-term lung health
• Early detection and accurate diagnosis of lung cancer to guide timely treatment planning
• Confirming or ruling out serious infection to start the most effective, targeted therapy
• Reducing uncertainty after abnormal imaging by obtaining a definitive tissue sample diagnosis
• Guiding next-step care for persistent respiratory symptoms (e.g., chronic cough or unexplained shortness of breath)
• Helping specialists tailor treatment for inflammatory or other pulmonary disease based on pathology results
• Supporting safe, evidence-based decisions about surveillance vs. treatment when a lesion may be benign