Ronaldo Ortiz-Pacheco, MD, tells patients to think of the lungs as a tree. 

The main windpipe, or trachea, is the trunk of the tree, and it’s hollow on the inside. It divides into two big bronchial branches, and “then they start dividing into basically little microscopic berries, if you will.” Cancers can arise in any portion of the tracheal-bronchial tree, or in the parenchyma, or meat of the lung. 

Biopsies, to obtain a sample of cells or tissue, are done to get a diagnosis. The way they’re done depends on the size and location of the nodule, or area of concern. 

An interventional radiologist may insert a needle through the skin, into the lung and into the nodule. Or a surgeon or pulmonologist could do a bronchoscopy, in which the nodule is accessed through the windpipe. 

At Upstate, doctors have the option of using an endoluminal system that is basically a robotic bronchoscopy. Ortiz-Pacheco says it’s like having your esophagus checked in an endoscopy procedure or your colon checked in a colonoscopy. Doctors use a control panel to navigate the robot in the airways. 

“We make a virtual map of the lungs using a preexisting CT (computerized tomography) scan. We make a virtual image of the nodule. And the bronchoscope kind of makes a path which we follow, based on the imaging that we have,” he explains. 

“It’s a 3D image, superimposed onto a live view, and we can drive up to the area in question and then biopsy the nodule with needles, forceps, cytology brushing (to collect sample cells), just to maximize the amount of cells that we can get to identify what exactly is going on with that nodule.” 

Ortiz-Pacheco says the robotic bronchoscopy also allows lymph nodes in the chest to be examined at the same time. 

Results typically are available within three to five days. And remember, not all nodules are cancer. 

Hear Pacheco go into more detail on lung biopsies in an interview with “The Informed Patient” podcast.

This article appears in the Winter 2025 issue of Cancer Care magazine.