lung biopsy

how safe is it for a person with emphysema to have a needle biopsy?  Is a pulmonologist able to determine how advanced the emphysema is to accurately determine if they are a good candidate for a biopsy?  Also, when a biopsy is done of a lung nodule, is it common to take a sample from "Emphysema like" tissue.  Does the radiologist have the authority/knowledge to make that decision?  Any expertise would be greatly appreciated.
Thanks, michelle

[Fernando Roque, MD]

Hi.  I can understand your concern. There is a chance that an emphysematous bulla (an abnormal air-filled sac inside the lung which signifies damage from the emphysema) can  rupture if a biopsy needle goes through it.  But usually, the needle biopsy is guided by CAT scan, so the doctor doing the procedure is not doing it blindly, and can avoid going through potentially problematic areas.  A pulmonologist or a radiologist is trained to do this kind of biopsy.  Biopsy samples are usually taken from areas which are suspicious for cancer.  If your doctor got samples from another area, you could ask him why he did that.  There might be a good reason for it.

[michelle7348]

Thank you for you comment.  The reason I ask is because my grandmother went in for a biopsy of a lung nodule on the 26th of December and the radiologist doing it said he saw "emphysema like" tissue and decided to take a sample of it.  When he did this it collapsed her lung.  Over the course of 4 weeks she had, at one point, 4 different chest tubes because she had sub Q emphysema all over her body.  It was so bad two different times she had to be intubated.  She passed away this Friday and we are just trying to deal with the fact that she walked into the hospital the day of the biopsy and never left.  The bottom line is is this something the radiologist had the authority to do?  We are not sure why tissue would need to be taken from an area that was obviously already weak.    
Thanks again, michelle

[Fernando Roque, MD]

Hi.  I'm not really sure why the radiologist decided to take a sample of that "emphysema like" tissue, so I'm not really in a position to comment whether he was "in authority" to do it or not.  A lot of decisions in medicine are judgment calls, and in a lot of cases, the doctor decides based on what he thinks best at the time the decision was taken.  Sometimes those decisions result in unfortunate circumstances, like what happened in your grandmother's case.  I think you should really talk with your doctor about this.  At the very least, he owes you an explanation for the things that have happened.