Pleural needle biopsy

Definition

Pleural biopsy is a procedure to remove a sample of the tissue lining the lungs and the inside of the chest wall to check for disease or infection.

Alternative Names

Closed pleural biopsy; Needle biopsy of the pleura

How the Test is Performed

This test may be done in the hospital. It may also be done at a clinic or doctor's office.

The procedure involves the following:

• During the procedure, you are sitting up.
• Your health care provider cleanses the skin at the biopsy site.
• Numbing drug (anesthetic) is injected through the skin and into the lining of the lungs and chest wall (pleural membrane).
• A larger, hollow needle is then placed gently through the skin into the chest cavity. Sometimes, the provider uses ultrasound or CT imaging to guide the needle.
• A smaller cutting needle inside the hollow one is used to collect tissue samples. During this part of the procedure, you are asked to sing, hum, or say "eee." This helps prevent air from getting into the chest cavity, which can cause the lung to collapse (pneumothorax). Usually, three or more biopsy samples are taken.
• When the test finished, a bandage is placed over the biopsy site.

In some cases, pleural biopsy is done using a fiberoptic scope. The scope allows the doctor to view the area of the pleura from which the biopsies are taken.

How to Prepare for the Test

You will have blood tests before the biopsy. You will likely have a chest x-ray.

How the Test will Feel

When the local anesthetic is injected, you may feel a brief prick (like when an intravenous line is placed) and a burning sensation. When the biopsy needle is inserted, you may feel pressure. As the needle is being removed, you may feel tugging.

Why the Test is Performed

Pleural biopsy is usually done to find the cause of a collection of fluid around the lung (pleural effusion) or other abnormality of the pleural membrane. Pleural biopsy can diagnose tuberculosis, cancer, and other diseases.

If this type of pleural biopsy is not enough to make a diagnosis, you may need a surgical biopsy of the pleura.

Normal Results

Pleural tissues appear normal, without signs of inflammation, infection, or cancer.

What Abnormal Results Mean

Abnormal results may reveal cancer (including primary lung cancer, malignant mesothelioma, and metastatic pleural tumor), tuberculosis, other infections, or collagen vascular disease.

Risks

There is a slight chance of the needle puncturing the wall of the lung, which can partially collapse the lung. This usually gets better on its own. Sometimes, a chest tube is needed to drain the air and expand the lung.

There is also a chance of excessive blood loss.

Considerations

If a closed pleural biopsy is not enough to make a diagnosis, you may need a surgical biopsy of the pleura.

References

Klein JS, Bhave AD. Thoracic radiology: invasive diagnostic imaging and image-guided interventions. In: Broaddus VC, Mason RJ, Ernst JD, et al, eds. Murray and Nadel's Textbook of Respiratory Medicine. 6th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 19.

Verschakelen JA, Gleeson F. The chest wall, pleura, diaphragm and intervention. In: Adam A, Dixon AK, Gillard JH Schaefer-Prokop CM, eds. Grainger & Allison's Diagnostic Radiology: A Textbook of Medical Imaging. 6th ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2015:chap 10.