Pleural needle biopsy

Answer 1

Definition

A 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 does not have to be done in the hospital. It may be done at a clinic or doctor's office.

You will be sitting up for the biopsy. The health care provider will cleanse the skin at the biopsy site, and inject a local numbing drug (anesthetic) through the skin and into the lining of the lungs and chest wall (pleural membrane).

A larger, hollow needle is then placed through the skin and into the chest cavity. The doctor rotates the needle. At various times during the procedure, you will be asked to sing, hum, or say "eee." This helps prevent air from getting into the chest cavity, which can cause a lung collapse (pneumothorax).

The doctor removes the needle to collect tissue samples. Usually, 3 biopsy samples are taken. When the test is completed, a bandage is placed over the biopsy site.

How to prepare for the test

You will have blood tests before the biopsy, and you may have a chest x-ray taken. You must sign consent forms.

How the test will feel

With the injection of the local anesthetic, you may feel a brief prick and a burning sensation. When the biopsy needle is inserted, you may feel pressure. As the needle is being removed, you may feel a tugging sensation.

Why the test is performed

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

Normal Values

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

Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results.

What abnormal results mean

Abnormal results may reveal cancer, tuberculosis, a viral disease, a fungal disease, a parasitic disease, or collagen vascular disease.

Other conditions under which the test may be done include:

• Malignant mesothelioma
• Metastatic pleural tumor
• Primary lung cancer

What the risks are

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. There is a chance of excessive blood loss.

Special considerations

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

References

Broaddus VC, Light RW. Pleural Effusion. In: Mason RJ, Murray J, Broaddus VC, Nadel JA. Textbook of Respiratory Medicine. 4th ed. Philadelphia, Pa: WB Saunders; 2005: chap 68.

Ernst A, Silvestri GA, Johnstone D. Interventional Pulmonary Procedures: Guidelines from the American College of Chest Physicians. Chest. May 2003: Vol. 123; pp. 1693-1717.

Answer 2

Definition

A 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 does not have to be done in the hospital. It may be done at a clinic or doctor's office.

You will be sitting up for the biopsy. The health care provider will cleanse the skin at the biopsy site, and inject a local numbing drug (anesthetic) through the skin and into the lining of the lungs and chest wall (pleural membrane).

A larger, hollow needle is then placed through the skin and into the chest cavity. A smaller cutting needle is iniside the hollow one. The doctor rotates the smaller needle. At various times during the procedure, you will be asked to sing, hum, or say "eee." This helps prevent air from getting into the chest cavity, which can cause a lung collapse (pneumothorax).

The doctor removes the needle to collect tissue samples. Usually, three biopsy samples are taken. When the test is completed, a bandage is placed over the biopsy site.

The needle biopsy obtains “blindly” pleural tissue. The test has been progressively replaced by pleural biopsy using a fiberoptic scope, where the doctor actually sees 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, and you may have a chest x-ray taken. You must sign consent forms.

How the test will feel

With the injection of the local anesthetic, 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 a tugging sensation.

Why the test is performed

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

Normal Values

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

Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results.

What abnormal results mean

Abnormal results may reveal cancer (including primary lung cancer, malignant mesothelioma, and metastatic pleural tumor), tuberculosis, a viral disease, a fungal disease, a parasitic disease, or collagen vascular disease.

What the risks are

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, the patient needs a chest tube to drain the air and expand the lung.

There is also a chance of excessive blood loss.

Special considerations

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

References

Broaddus VC, Light RW. Pleural effusion. In: Mason RJ, Broaddus VC, Martin TR, et al. Murray & Nadel's Textbook of Respiratory Medicine. 5th ed. Philadelphia, Pa: WB Saunders; 2010:chap 73.

Ernst A, Silvestri GA, Johnstone D. Interventional pulmonary procedures: guidelines from the American College of Chest Physicians. Chest. 2003;123:1693-1717.

Reviewed By

Review Date: 12/12/2011

Denis Hadjiliadis, MD, Assistant Professor of Medicine, Division of Pulmonary, Allergy and Critical Care, University of Pennsylvania, Philadelphia, PA. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.