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The following diagnostic tests are usually performed to identify the exact type of cancer and also to complete the staging workup:

• Biopsy - A sample of tissue or cells is obtained from the area of the tumor and is examined under a microscope to look for the presence of cancer cells. A biopsy is usually necessary to confirm the presence of lung cancer and can be performed by one of several different techniques:

  • Needle biopsy - A sample of tissue is obtained by inserting a fine needle through the chest wall and the tissue is examined under a microscope to look for the presence of cancer cells.

  • Bronchoscopy - While the patient is sedated, a flexible, lighted tube called a bronchoscope is inserted through the nose or mouth into the trachea and lungs. A sample of tissue is then obtained and examined for the presence of cancer cells.

  • Mediastinoscopy - This is a surgical procedure that allows the doctor to view the mediastinum - the space within the chest located between the lungs that contains the heart, major blood vessels, trachea, and esophagus. With the patient under general anesthesia, the surgeon makes a small incision just below the neck and inserts a special lighted tube called a mediastinoscope through the incision. A sample of tissue is then obtained from the mediastinal lymph nodes and the specimen is examined under a microscope for the presence of cancer cells. Complications of this procedure, which occur in about 2% of patients, may include: 1) pneumothorax - partial or complete collapse of the lung; 2) injury to the left recurrent laryngeal nerve; 3) bleeding; and 4) infection.

  • Video-assisted thoracic surgery (VATS) - This is a new, minimally invasive surgical procedure that enables surgeons to perform an operation through 2 to 4 tiny openings between the ribs while at the same time viewing the patient's internal organs on a television monitor. VATS can be used to obtain a sample of tissue from a lung tumor to check for the presence of cancer. It is important to note that not all tumors within the lungs are lung cancer and some tumors may be benign.

  • Thoracentesis - This is a procedure where a needle is inserted through the skin of the chest wall into the pleural space (the space between the lining of the outside of the lungs) and fluid is removed and checked for the presence of cancer cells.