Pleural biopsy
A pleural biopsy is a medical procedure that involves the removal of a sample from the pleura, the membrane surrounding the lungs, for diagnostic testing. It is primarily conducted to investigate potential diseases such as lung cancer or mesothelioma, particularly when imaging tests indicate abnormalities like thickening or masses in the pleura. The procedure can be performed in various settings, including a doctor's office or hospital, usually under local anesthesia.
During a pleural biopsy, the physician may use a large-bore needle for a percutaneous biopsy or opt for a thoracoscopy or open biopsy to obtain larger tissue samples. Utilizing ultrasound guidance can enhance the accuracy of the needle placement. After the biopsy, the sample is sent to a laboratory for analysis, which may take several days to yield results regarding the presence of cancer cells.
While pleural biopsy is generally safe, it carries some risks, including respiratory distress, pneumothorax, and bleeding. Post-procedure, patients are advised to monitor for any concerning symptoms, such as shortness of breath or light-headedness. This procedure is essential for accurate diagnosis and subsequent treatment planning for lung-related diseases.
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Subject Terms
Pleural biopsy
ALSO KNOWN AS: Needle biopsy of the pleura, open pleural biopsy, closed pleural biopsy
DEFINITION: A pleural biopsy is the removal of a sample of the pleura (the membrane that surrounds the lungs) so that it can be tested by a pathologist for cancer or other diseases.
Cancers diagnosed:Lung cancer, metastatic pleural tumor, pleural mesothelioma
Why performed: This test may be used to diagnose mesothelioma, a tumor in the pleural membrane, or lung cancer. It is indicated when a pleural fluid sample shows possible cancer, or a chest X-ray shows a thickening or mass in the pleura.
Patient preparation: Pleural biopsy may be done in a doctor’s office or hospital using a local anesthetic. A blood test may be required before the test to ensure that the patient does not have prolonged bleeding or clotting time.
Steps of the procedure: In a percutaneous biopsy, the doctor uses a large-bore needle. The skin around the site is cleaned and injected with a local anesthetic. The patient sits up and may be asked to hold their breath to prevent air from entering the chest during the procedure. The physician makes an and inserts the needle through the chest wall and into the pleura. Ultrasound can be used to help view the progress of the needle. When it is in place, a biopsy trocar is inserted through the needle to remove a tissue sample. The doctor usually removes three samples, places them in a fixative, and sends them to the laboratory. The procedure can take less than thirty minutes.
To obtain larger specimens of the pleura, the biopsy can also be performed during a thoracoscopy using a laparoscope (a tube with a tiny camera on the end) that the doctor inserts through the skin and into the chest or as an open pleural biopsy, a surgery performed under general anesthesia. Advances including cryoprobe biopsy have allowed doctors to retrieve larger samples with fewer complications.
After the procedure: A bandage is placed over the incision. The patient is observed for respiratory distress and bleeding. After returning home, the patient should be aware of any shortness of breath. Light-headedness or an increased pulse rate might indicate internal bleeding.
Risks: Potential complications from this procedure include respiratory distress, pneumothorax (presence of air in the chest outside the lung), injury to the lung, infection, and bleeding.
Results: Preparation of a tissue sample and analysis by a pathologist may take several days. The pathologist can identify the presence or apparent lack of cancer cells in the tissue.
Bibliography
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National Comprehensive Cancer Network. NCCN Guidelines for Patients: Malignant Pleural Mesothelioma. Fort Washington: Natl. Comprehensive Cancer Network, 2014.
“Pleural Biopsy.” Johns Hopkins Medicine, www.hopkinsmedicine.org/health/treatment-tests-and-therapies/pleural-biopsy. Accessed 19 June 2024.
Pugh, Spencer, and Zab Mosenifar. “Pleural Biopsy: Overview, Indications, Closed Needle Pleural Biopsy.” Medscape Reference, 14 Aug. 2019, emedicine.medscape.com/article/1894279-overview?form=fpf. Accessed 19 June 2024.