Pleural biopsy is a procedure to remove a sample of the pleura. This is the thin tissue that lines the chest cavity and surrounds the lungs. The biopsy is done to check the pleura for disease of infection.
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.
Pleural tissues appear normal, without signs of inflammation, infection, or cancer.
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.
If a closed pleural biopsy is not enough to make a diagnosis, you may need a surgical biopsy of the pleura.
Closed pleural biopsy; Needle biopsy of the pleura
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.
Reed JC. Pleural effusions. In: Reed JC, ed. Chest Radiology: Patterns and Differential Diagnoses. 7th ed. Philadelphia, PA: Elsevier; 2018:chap 4.
Review Date 7/11/2019
Updated by: Michael M. Phillips, MD, Clinical Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.