How Is Lung Cancer Biopsy Performed? (2026 Guide)

Lung cancer biopsy begins after a suspicious lesion is found on chest CT, followed by tissue sampling—via bronchoscopy, CT-guided needle biopsy, or surgical biopsy, depending on the lesion's location—to confirm whether it is cancer and determine the tissue type.

Key Takeaways

• There are three main biopsy methods—bronchoscopy (including endobronchial ultrasound-guided biopsy), CT-guided needle biopsy, and surgical biopsy—and the choice depends on where the lesion is located.
• The biopsy determines whether the lesion is lung cancer, whether it is non-small cell lung cancer (NSCLC) or small cell lung cancer (SCLC), and if NSCLC, which specific histologic subtype it is.
• Whether cancer has spread to mediastinal lymph nodes is a key factor determining surgical candidacy, so if needed, endobronchial ultrasound (EBUS) is used to directly sample the lymph nodes.
• For advanced or metastatic NSCLC, the same biopsy tissue is used to test for genetic alterations such as EGFR, ALK, and ROS1, as well as PD-L1 expression; next-generation sequencing (NGS), which examines multiple genes at once, is commonly used.
• Korea's 5-year relative survival rate for lung cancer is 42.5% (National Cancer Registry Statistics, 2019–2023); this is a nationwide figure, not the outcome of any single hospital.

Why Does the Process Start With a CT Scan?

• Finding a suspicious lesion on chest CT is the starting point. Imaging alone cannot confirm cancer—a biopsy, which involves removing actual tissue for microscopic examination, is essential for diagnosis.
• If the lesion is near a bronchus, bronchoscopy is often used; if it is toward the outer lung or close to the chest wall, CT-guided needle biopsy is more common. If these methods cannot confirm the diagnosis, surgical biopsy may be considered. Lesion location is the key factor determining which method is used.

What Can Biopsy Results Reveal?

• A biopsy does more than confirm whether cancer is present—it also determines whether the cancer is NSCLC or SCLC, and if NSCLC, which histologic subtype it is. These results form the starting point for deciding subsequent treatment direction.
• For advanced or metastatic NSCLC, the same tissue sample must also be tested for genetic alterations such as EGFR, ALK, ROS1, BRAF, KRAS, MET, RET, and NTRK, along with PD-L1 expression, to select appropriate drug therapy. NGS testing, which examines multiple genes simultaneously, is widely used for this purpose.

What Is the Order of Testing?

• Step 1 — Chest CT identifies the location of the suspicious lesion.
• Step 2 — Tissue is obtained using the method appropriate to the lesion's location (bronchoscopy, CT-guided needle biopsy, or surgical biopsy).
• Step 3 — The biopsy confirms the cancer type and histologic subtype; if needed, the same tissue is used for EGFR, ALK, and other biomarker testing, PD-L1, and NGS.
• Step 4 — PET-CT checks for lymph node and distant organ metastasis, and brain MRI checks for brain metastasis, to determine the stage. If mediastinal lymph node involvement is suspected, EBUS is used to directly sample the nodes.
• Step 5 — If surgery is being considered, pulmonary function tests and cardiac evaluation are performed together to assess whether the patient can tolerate surgery.

FAQ — Can Biopsy Results From My Home Country Be Used As-Is?

Yes. If results from your home country are available, they can be used as they are. If results are missing or incomplete, tissue slides or paraffin blocks can be sent to Korea for NGS testing, or testing can be performed after arrival. Useful records for international patients to prepare include the original biopsy and pathology reports, and if possible, the tissue slides or paraffin blocks themselves.

FAQ — Can Staging Be Determined From the Biopsy Alone?

No. A biopsy determines the cancer type and histologic subtype, while staging is determined using the TNM system after reviewing PET-CT (for lymph node and distant metastasis) and brain MRI (for brain metastasis) together. NSCLC is broadly classified into stages I–II (confined to the lung), stage III (mediastinal lymph node involvement), and stage IV (distant metastasis). Biopsy results and staging results together are needed to establish a treatment plan.

Sources and Notes

• This article was written based on materials from the National Cancer Information Center, National Cancer Center Korea, NCCN Patient Guidelines, and SEER (National Cancer Registry Statistics 2019–2023 and SEER 2016–2022).
• This content is provided for general medical information purposes only. Diagnosis and treatment methods and outcomes may vary depending on individual circumstances. Please consult with medical professionals to determine accurate diagnosis and treatment.