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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. Or it may be done at a clinic or doctor's office.

The procedure involves the following:

  • During the procedure, you are sitting up.
  • The 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.
  • 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 biopsy samples are taken.
  • When the test is completed, 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 may 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 a closed 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, a viral disease, a fungal disease, a parasitic disease, 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

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

Jaroszewski DE, Viggiano RW, Leslie KO. Optimal processing of diagnostic lung specimens. In Leslie KO, Wick MR, eds. Practical Pulmonary Pathology: A Diagnostic Approach. 2nd ed. Philadelphia, Pa: Elsevier Saunders; 2011:chap 2.


Review Date: 10/14/2013
Reviewed By: George F. Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program, San Diego, California. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.
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