Upper airway biopsy
Biopsy - upper airway
Upper airway biopsy is surgery to remove a small piece of tissue from the nose, mouth, and throat area. The tissue will be examined under the microscope by a pathologist.
An upper airway biopsy is obtained by using a flexible scope called a bronchoscope. The scope is passed down through the mouth and throat and a small piece of tissue is removed and sent to the laboratory. This test may be performed when an abnormality of the upper airway is suspected. It may also be performed as part of a bronchoscopy when abnormalities include the upper airway as well as the lung tissue.
Bronchoscopy is a surgical technique for viewing the interior of the airways. Using sophisticated flexible fiber optic instruments, surgeons are able to explore the trachea, main stem bronchi, and some of the small bronchi. In children, this procedure may be used to remove foreign objects that have been inhaled. In adults, the procedure is most often used to take samples of (biopsy) suspicious lesions and for culturing specific areas in the lung.
Structures of the throat include the esophagus, trachea, epiglottis and tonsils.
How the Test is Performed
The health care provider will spray a numbing medicine in your mouth and throat. A metal tube is inserted to hold your tongue out of the way.
Another numbing medicine flows through the tube down the back of the throat. This may cause you to cough at first. When the area feels thick or swollen, it is numb.
The test may also be performed under general anesthesia, so that you will be asleep and not feel pain.
The provider looks at the abnormal area, and removes a small piece of tissue. It is sent to the laboratory for examination.
How to Prepare for the Test
DO NOT eat for 6 to 12 hours before the test.
Tell your provider if you take a blood thinner, such as aspirin, clopidogrel, or warfarin, when you schedule the biopsy. You may need to stop taking them for a little while. Never stop taking any medicines without first talking to your provider.
How the Test will Feel
As the area is being numbed, you may feel like there is fluid running down the back of your throat. You may feel the need to cough or gag. And you may feel pressure or mild tugging.
When the numbness wears off, your throat may feel scratchy for several days. After the test, the cough reflex will return in 1 to 2 hours. Then you may eat and drink normally.
Why the Test is Performed
This test may be done if your provider thinks there is a problem with your upper airway. It may also be done with a bronchoscopy.
Normal Results
The upper airway tissues are normal, with no abnormal growths.
What Abnormal Results Mean
Disorders or conditions that may be discovered include:
- Benign (noncancerous) cysts or masses
- Cancer
- Certain infections
- Granulomas and related inflammation (may be caused by tuberculosis)
- Autoimmune disorders, such as granulomatosis with polyangiitis
- Necrotizing vasculitis
Risks
Risks for this procedure include:
- Bleeding (some bleeding is common, heavy bleeding is not)
- Breathing difficulties
- Sore throat
There is a risk of choking if you swallow water or food before the numbness wears off.
References
Barbareschi M, Mengoli MC, Cavazza A. Nonneoplastic pathology of the large and small airways. In: Smith ML, Leslie KO, Wick MR, eds. Practical Pulmonary Pathology. 4th ed. Philadelphia, PA: Elsevier; 2024:chap 9.
Mason JC. Rheumatic diseases and the cardiovascular system. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 97.
White V, Ruparelia P. Respiratory disease. In: Feather A, Randall D, Waterhouse M, eds. Kumar and Clark's Clinical Medicine. 10th ed. Philadelphia, PA: Elsevier; 2021:chap 28.
Yu DH, Feller-Kopman D. Tracheobronchial endoscopy. In: Flint PW, Francis HW, Haughey BH, et al, eds. Cummings Otolaryngology: Head and Neck Surgery. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 71.
Version Info
Last reviewed on: 11/29/2022
Reviewed by: Josef Shargorodsky, MD, MPH, Johns Hopkins University School of Medicine, Baltimore, MD. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
