Bronchial and transbronchial biopsy (Bronchial biopsy and transbronchial lung biopsy)
Taking small tissue samples from inside the airways, or from the surrounding lung, during a bronchoscopy so they can be examined under a microscope.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- These biopsies take small tissue samples from the airway lining (bronchial) or the surrounding lung (transbronchial) during a bronchoscopy.
- A transbronchial biopsy can cause a collapsed lung (pneumothorax) or bleeding more often than an ordinary bronchoscopy, and a freezing 'cryobiopsy' carries more risk again.
- It is usually a day-case test, though you may be watched for longer or have a chest X-ray afterwards to check for a collapsed lung.
- A small sample does not always give a firm answer, so be clear about what happens if the result is inconclusive.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your specialist will give you advice for your situation.
Gives a tissue sample that can be examined under a microscope, not just a visual look
You have a bleeding tendency or are on blood thinners that cannot be safely paused.
You are sedated and awake, or asleep under general anaesthetic for a cryobiopsy, with your throat numbed and your oxygen and heart rate monitored.
Clear written instructions on warning signs of a collapsed lung and bleeding, and who to contact out of hours.
You are sedated and awake, or asleep under general anaesthetic for a cryobiopsy, with your throat numbed and your...
You recover in a monitored area. After a transbronchial biopsy you may have a chest X-ray to check for a collapsed...
Expect to feel tired. If sedated, do not drive, work, drink alcohol, use machinery or sign legal documents for 24...
A sore throat, mild cough and small specks of blood can be normal. New breathlessness or chest pain may mean a...
What is a bronchial or transbronchial biopsy?
A biopsy means taking a small sample of tissue so it can be examined under a microscope. These biopsies are taken during a bronchoscopy, when a thin camera tube is passed into your airways.
A bronchial (or endobronchial) biopsy takes a sample from an abnormal area on the lining of an airway itself — for example a lump or rough patch the doctor can see. A transbronchial biopsy goes a step further: small forceps, or a freezing probe (a cryobiopsy), are passed through the airway wall to sample the lung tissue beyond it. This is used to investigate conditions such as scarring of the lungs (interstitial lung disease), sarcoidosis, infection or cancer.
Because a transbronchial biopsy samples the lung tissue, it carries a higher chance of a collapsed lung (pneumothorax) or bleeding than an ordinary bronchoscopy. A cryobiopsy gives larger samples but tends to carry more bleeding and pneumothorax risk than forceps.
A biopsy gives more information than just looking, but it is still only a small sample and does not always give a firm answer. This guide explains what to expect; it is not personal medical advice.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Forceps transbronchial biopsy compared with cryobiopsy
| Point | Forceps biopsy | Cryobiopsy |
|---|---|---|
| Sample size | Small | Larger, better quality |
| Anaesthetic | Often sedation | Usually general anaesthetic |
| Bleeding risk | Lower | Higher |
| Pneumothorax risk | Lower | Higher |
Your respiratory physician chooses the method based on what is being investigated and your safety. Cryobiopsy is done in centres with extra safeguards.
Preparing for your test
- You will usually be asked not to eat for about 6 hours before, with clear fluids until about 2 hours before — follow your unit's exact times.
- Tell the team about all your medicines, especially blood thinners such as warfarin, aspirin, clopidogrel, apixaban, rivaroxaban, edoxaban or dabigatran. Some people need a temporary change before this procedure, but the plan differs by medicine, the exact procedure and their risk of bleeding or blood clots. Do not stop, skip or restart any of these medicines unless the team responsible for your procedure gives you specific instructions.
- You may need a blood test to check how well your blood clots, and your kidney function may be checked.
- Ask for clear instructions about diabetes medicines, which often need adjusting on the day.
- Mention any heart or lung condition, allergies, or previous reaction to sedation or anaesthetic.
- Arrange for a responsible adult to take you home and, ideally, stay with you overnight.
- Plan not to drive, work, drink alcohol or sign legal documents for 24 hours after sedation, and bring your inhalers and medicines list.
What happens
The biopsy is taken during a bronchoscopy. Local anaesthetic is sprayed onto your throat and most people are given a sedative, though a cryobiopsy is usually done under a general anaesthetic. Your oxygen level and heart rate are monitored throughout and you are given oxygen.
The camera is passed into your airways. For a bronchial biopsy, small forceps take a sample from a visible abnormal area. For a transbronchial biopsy, forceps or a freezing probe are passed through the airway wall to sample the lung beyond, often using moving X-ray pictures to guide the doctor to the right place. Several samples may be taken.
Because a transbronchial biopsy carries a risk of a collapsed lung, you may have a chest X-ray afterwards and be watched for a few hours before going home. The whole bronchoscopy usually takes under an hour.
Is this test right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- You have a bleeding tendency or are on blood thinners that cannot be safely paused.
- You have raised pressure in the lung blood vessels (pulmonary hypertension), which increases bleeding risk from a transbronchial biopsy.
- Your lung function or oxygen level is too low to tolerate a possible collapsed lung safely.
- A less risky test, such as a scan or airway samples, could give the needed information.
Delay or rearrange if…
- You have an active chest infection or are acutely unwell, until this is treated and more stable.
- Your blood thinners have not been managed according to a clear plan.
- A clotting blood test or kidney check has not been done where needed.
- You cannot arrange a responsible adult to take you home after sedation.
- There is a chance you could be pregnant and this has not been discussed.
Alternatives to discuss
- A CT scan of the chest, which can sometimes give enough information without a biopsy
- A CT-guided lung biopsy for lesions in the outer lung
- EBUS gland sampling where the abnormality is in a lymph gland
- A surgical lung biopsy for larger, better-quality samples when needed
- Watchful waiting with repeat imaging for low-risk findings, if your team advises
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Comfort, sedation or contrast choices
If local anaesthetic, sedation, contrast or pain relief is used, ask what is planned, why, and what it means afterwards.
Benefits
- Gives a tissue sample that can be examined under a microscope, not just a visual look
- Can help diagnose lung scarring, sarcoidosis, infection or cancer
- A cryobiopsy gives larger, better-quality samples for difficult diagnoses
- May confirm a diagnosis without the need for a bigger surgical lung biopsy
- Helps guide the right treatment once the cause is known
Risks & complications
- A sore throat or hoarse voice for a day or two
- Coughing during and after the test
- Coughing up small amounts of blood for a few hours
- Feeling tired or drowsy for several hours from sedation
- A collapsed lung (pneumothorax), more common with transbronchial than bronchial biopsy
- Bleeding that is more than the usual specks of blood
- A chest infection needing antibiotics
- A drop in oxygen level or an irregular heartbeat during the test
- A collapsed lung large enough to need a chest drain
- Heavy bleeding needing treatment
- Worsening of an existing severe lung condition
- Serious complications, including very rarely a life-threatening problem in people who are already very unwell
The biggest specific risks are a collapsed lung (pneumothorax) and bleeding, and both are more likely with a transbronchial biopsy than a simple airway biopsy, and more likely again with cryobiopsy. Your risk is higher if you are on blood thinners, have raised pressure in the lung blood vessels, or already have severe lung disease. Ask your respiratory physician which type of biopsy is planned, what your personal risk is, whether you will have a chest X-ray afterwards, and exactly what warning signs to watch for.
Published figures to discuss
The risk of a collapsed lung or bleeding depends on the type of biopsy, your lung condition and any bleeding tendency. The ranges below come from published studies and meta-analyses, mostly in people having transbronchial biopsies for lung scarring; figures vary widely between centres and patients, and cryobiopsy generally carries more risk than forceps. They are cautious ranges, not a precise prediction for you.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Collapsed lung (pneumothorax) after forceps transbronchial biopsy | Around 1 in 14 people (roughly 7%, but varies widely) | Higher when sampling the upper parts of the lung. A simple bronchial (airway) biopsy carries far less risk. | Diagnostic yield and safety of transbronchial cryobiopsy and surgical lung biopsy in ILD — meta-analysis (European Respiratory Review)publications.ersnet.orgPublished figure |
| Collapsed lung after cryobiopsy | Roughly 1 in 11 people (around 9%, varying by centre), with about 1 in 18 needing a chest drain | Cryobiopsy gives larger samples but carries more pneumothorax risk; done in centres with safeguards. | Diagnostic yield and safety of transbronchial cryobiopsy and surgical lung biopsy in ILD — meta-analysis (European Respiratory Review)publications.ersnet.orgPublished figure |
| Moderate to severe bleeding after forceps transbronchial biopsy | Around 1 in 25 people (roughly 4%) | Higher with cryobiopsy. Coughing up small specks of blood is common and not the same thing. | Diagnostic yield and safety of transbronchial cryobiopsy and surgical lung biopsy in ILD — meta-analysis (European Respiratory Review)publications.ersnet.orgPublished figure |
| Significant bleeding after cryobiopsy | Roughly 1 in 10 people, lower in high-volume centres | One reason cryobiopsy is done under general anaesthetic with bleeding-control measures ready. | Diagnostic yield and safety of transbronchial cryobiopsy and surgical lung biopsy in ILD — meta-analysis (European Respiratory Review)publications.ersnet.orgPublished figure |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
There is no external wound, but because lung tissue may have been sampled you may be watched for a few hours and have a chest X-ray to check for a collapsed lung before you go home.
- A sore or scratchy throat and a hoarse voice for a day or two
- Coughing up small specks of blood for a few hours
- Feeling drowsy and forgetful for the rest of the day after sedation
- Mild chest discomfort that settles
- Waiting one to two weeks for results
Aftercare
- Do not eat or drink until the numbness in your throat has fully worn off.
- Have a responsible adult take you home and stay with you if you were sedated.
- Rest for the remainder of the day and avoid alcohol for 24 hours.
- Avoid air travel and vigorous exercise until your team confirms there is no collapsed lung, if you had a transbronchial biopsy.
- Take your usual inhalers and medicines as advised, and ask when to restart any blood thinners that were stopped.
- Watch closely for new breathlessness or chest pain in the days afterwards.
- Keep your follow-up appointment, and save the unit's out-of-hours contact number.
- Someone booked to drive you home and stay over if sedated
- Day off work and no driving planned for 24 hours after sedation
- Fasting instructions and clotting blood test arranged
- Plan agreed for stopping and restarting blood thinners
- Inhalers and medicines list packed
- Unit and out-of-hours contact number saved
- Follow-up appointment for results noted
⚠ Get urgent help if…
- New or worsening breathlessness in the hours or days afterwards (possible collapsed lung)
- Sharp chest pain, especially on breathing in
- Coughing up more than small specks of blood, or larger amounts of fresh blood
- A high fever, shivering or feeling very unwell (possible infection)
- A fast, pounding or irregular heartbeat
- Feeling faint, very short of breath or unwell enough to call for emergency help
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your specialist gives you.
Results & realistic expectations
The samples are examined under a microscope and sometimes tested for infection or specific markers, which is why a firm result usually takes a week or two. A clear result can confirm a diagnosis such as lung scarring, sarcoidosis, infection or cancer and guide treatment.
Because the sample is small, a transbronchial biopsy does not always capture the abnormal tissue, so a normal or inconclusive result does not always rule a diagnosis out. If the result is unclear, your respiratory physician may suggest a repeat biopsy, a cryobiopsy or a surgical lung biopsy. They will explain what your result means and the next step.
A biopsy reflects the tissue sampled at one point in time. If your condition changes or the result is unclear, a repeat or different biopsy may be needed. Diagnosing some conditions, such as lung scarring, often relies on combining the biopsy with scans and a team discussion rather than the biopsy alone.
Related tests, treatments or support
These biopsies are taken during a bronchoscopy and are often combined with washings, brushings or EBUS gland sampling. If they do not give an answer, a CT-guided lung biopsy or a surgical lung biopsy may be considered. Lung-scarring diagnoses are usually confirmed by a specialist team reviewing the biopsy alongside CT scans.
Follow-up & long-term care
Results are usually explained at a follow-up appointment within a week or two, sometimes as part of a specialist clinic or team discussion. You should be told who is coordinating your care, who to contact if results are delayed, and what to do if you develop warning signs of a collapsed lung or bleeding.
Repeat, follow-on and what comes next
- A small sample may miss the abnormal tissue, so an inconclusive result is not uncommon.
- A repeat biopsy, a cryobiopsy or a surgical lung biopsy is sometimes needed.
- Lung-scarring diagnoses usually depend on combining the biopsy with scans and a team discussion.
- Some specialist laboratory tests take longer than the routine result.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- Clear written instructions on warning signs of a collapsed lung and bleeding, and who to contact out of hours.
- A chest X-ray and a period of observation after a transbronchial biopsy where appropriate.
- A named route back to the respiratory team if you become unwell.
- A defined plan and appointment for explaining your results, including any team discussion for lung scarring.
- A clear plan for restarting any blood thinners that were stopped.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- Whether the biopsy is done under sedation or general anaesthetic (as for cryobiopsy)
- The respiratory physician's fee and the endoscopy unit or facility fee
- The type and number of biopsies taken, and whether X-ray guidance is used
- Laboratory and pathology charges for examining the samples
- Any observation period, chest X-ray or short stay needed after a transbronchial biopsy
- A follow-up appointment to discuss results, and any further tests if the result is inconclusive
- The respiratory physician's fee and the endoscopy or facility fee
- Sedation or general anaesthetic and monitoring costs
- Laboratory and pathology fees for all samples taken
- Any post-procedure chest X-ray, observation or short stay
- The cost of the follow-up appointment to explain your results
- What happens, and what it costs, if the result is inconclusive or a complication such as a collapsed lung needs treatment
On the NHS? These biopsies are standard NHS tests when clinically indicated; private access is mainly used for speed, choice of consultant or a second opinion rather than because the NHS does not offer them.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Not separating the higher risk of a transbronchial biopsy from a simple airway biopsy.
- Not explaining the extra bleeding and pneumothorax risk of cryobiopsy.
- Blood thinners or pulmonary hypertension not being properly considered before the biopsy.
- No clear warning signs for a delayed collapsed lung, or no out-of-hours contact.
- Not being told the sample may not give a firm answer.
Marketing red flags
- Calling a transbronchial biopsy a 'simple, low-risk sample' without mentioning collapsed lung and bleeding.
- Offering cryobiopsy without explaining it carries more risk and needs extra safeguards.
- Implying a normal biopsy completely rules out a serious lung condition.
- Not discussing safer alternatives such as a scan where reasonable.
Choosing a specialist safely
- Check the specialist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good specialist will welcome every one of these.
- Which type of biopsy am I having — airway lining, lung tissue with forceps, or a cryobiopsy — and why?
- What is my personal risk of a collapsed lung or bleeding, given my medicines and lung condition?
- Will I have a chest X-ray and observation afterwards to check for a collapsed lung?
- What will this result change about my treatment, and what happens if it is normal or inconclusive?
- What warning signs should make me seek urgent help, and who do I contact out of hours?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the specialist who carries out my test, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this test not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Is this biopsy available on the NHS?
Will the biopsy hurt?
How likely is a collapsed lung?
Why might I need a general anaesthetic?
When will I get my results?
What if the biopsy does not give an answer?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: British Thoracic Society — Diagnostic flexible bronchoscopy guideline (NICE-accredited) Diagnostic yield and safety of transbronchial cryobiopsy and surgical lung biopsy in ILD — meta-analysis (European Respiratory Review) Transbronchial biopsy and pneumothorax risk — BMC Pulmonary Medicine Cancer Research UK — Bronchoscopy North Bristol NHS Trust — Bronchoscopy
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
Related guides: Bronchoscopy · Endobronchial ultrasound (EBUS) · CT-guided lung biopsy · Pleural aspiration (chest drain) · Body plethysmography (lung volume test)