What is a pleural biopsy?

A biopsy is a procedure done to remove a tissue sample from the body so it can be examined. The pleura is a double layer of membranes that surrounds the lungs. A pleural biopsy is a procedure to remove a small piece of the pleura. This is done with a special biopsy needle. Or it’s done during surgery. The biopsy is done to look for infection, cancer, or another condition.

There are 3 types of pleural biopsy:

• Needle biopsy. The healthcare provider puts a numbing medicine (local anesthetic) on the chest. They put a special needle into the pleural membrane to take out a sample. Imaging such as an ultrasound (high-frequency sound waves) or a CT scan (a series of X-rays and a computer) may be used to guide the biopsy needle into the right place.

• Thoracoscopic biopsy. The healthcare provider numbs the skin of the chest and gives sedating medicines to make you sleepy. Sometimes, general anesthesia is used. A flexible, lighted tube (endoscope) is put into the pleural space. This is the space between the two layers of pleura. The endoscope lets the healthcare provider see the pleura and take a piece of tissue.

• Open biopsy. This is done under general anesthesia. This method is used by the healthcare provider if the sample from the needle biopsy is too small to get a diagnosis. The provider will make a cut (incision) in the skin to access the lung. They then remove a piece of the pleura.

Why might I need a pleural biopsy?

A pleural biopsy may be done to:

• Check an abnormal spot of the pleura seen on a chest X-ray or other imaging test

• Find the cause of a pleural infection or other condition

• Look for the cause of excess fluid in the pleural space (pleural effusion)

• Find out if a pleural tumor is cancer (malignant) or not cancer (benign)

• Get more information after a pleural fluid test shows there may be cancer, tuberculosis (TB), or another infection

Your healthcare provider may also have other reasons to advise a pleural biopsy.

What are the risks of a pleural biopsy?

All procedures have some risks. The risks of this procedure may include:

• Air in the space between the pleura (pleural space) that causes the lung to collapse (pneumothorax)

• Bleeding in the lung

• Infection

Your risks may vary depending on your general health and other factors. Ask your healthcare provider which risks apply most to you. Talk with them about any concerns you have.

Pleural biopsy shouldn’t be done in people with certain bleeding conditions.

How do I get ready for a pleural biopsy?

Your healthcare provider will explain the procedure to you. Ask any questions you have. Your provider may ask you to sign a consent form that gives permission to do the procedure. Read the form carefully. Before you sign the form, ask questions if anything is not clear.

Tell your healthcare provider if you:

• Are pregnant or think you may be pregnant

• Are sensitive to or allergic to any medicines, latex, tape, or anesthetic medicines (local and general)

• Take any medicines, including prescriptions, over-the-counter medicines, vitamins, and herbal supplements

• Have had a bleeding disorder

• Take blood-thinning medicine (anticoagulant), aspirin, or other medicines that affect blood clotting

Also:

• Stop taking certain medicines before the procedure, if instructed by your healthcare provider.

• Plan to have someone drive you home from the hospital.

• Follow any other instructions your healthcare provider gives you.

You may have imaging tests before the procedure. These are done to find the right spot to do the biopsy. You may have any of the below:

• Chest X-ray

• Chest fluoroscopy

• Ultrasound

• CT scan

What happens during a pleural biopsy?

You may have your procedure as an outpatient. This means you go home the same day. Or it may be done as part of a longer stay in the hospital. The way the procedure is done may vary. It depends on your condition and your healthcare provider's methods. In most cases, a needle biopsy will follow this process:

1. Your healthcare provider may ask you to remove your clothes. If so, you will be given a hospital gown to wear. They may ask you to remove jewelry or other objects.

2. Your healthcare provider may give you oxygen through a nasal tube or face mask. They will watch your heart rate, blood pressure, and breathing during the procedure.

3. For a needle biopsy, you may be in a sitting position in a hospital bed. Your arms will be resting on an over-bed table. This position helps to spread out the spaces between the ribs, which is where the needle is inserted. If you are not able to sit, you may lie on your side on the edge of the bed.

4. Your healthcare provider will clean the skin where the needle will be put in with an antiseptic solution.

5. Your healthcare provider will inject a numbing medicine (local anesthetic) in the biopsy site.

6. When the area is numb, the healthcare provider will put a needle between the ribs in your back. You may feel some pressure where the needle goes in. One or more samples of pleural tissue will be removed.

7. Your healthcare provider may ask you to hold still, exhale deeply, or hold your breath at certain times during the procedure.

8. The biopsy needle will be removed. Your healthcare provider will apply firm pressure to the site until any bleeding has stopped. A bandage or dressing will be put on the area.

9. The tissue samples will be sent to a lab.

10. You may have a chest X-ray taken right after the biopsy.

What happens after a pleural biopsy?

After the procedure, your healthcare provider will watch your blood pressure, pulse, and breathing. You may have another chest X-ray done a few hours after the procedure. Your provider will check the dressing over the puncture site for bleeding or other fluid.

If you had an outpatient procedure, you will go home when your healthcare provider says it’s OK. Someone may need to drive you home.

At home, you can go back to your normal diet and activities, if instructed by your healthcare provider. You may be told not to do strenuous physical activity for a few days.

The biopsy site may be tender or sore for several days. You can take pain medicine as advised by your healthcare provider. Aspirin and certain other pain medicines may increase bleeding. Make sure to take only the medicines your healthcare provider advises.

Call your healthcare provider if you have any of the below:

• Fever of 100.4°F (38°C) or higher, or as advised by your healthcare provider

• Redness or swelling of the needle site

• Blood or other fluid leaking from the needle site

• Feeling short of breath

• Coughing up blood

• Chest pain

Your healthcare provider may give you other instructions after the procedure.

Next steps

Before you agree to the test or the procedure make sure you know:

• The name of the test or procedure

• The reason you are having the test or procedure

• What results to expect and what they mean

• The risks and benefits of the test or procedure

• What the possible side effects or complications are

• When and where you are to have the test or procedure

• Who will do the test or procedure and what that person’s qualifications are

• What would happen if you did not have the test or procedure

• Any alternative tests or procedures to think about

• When and how will you get the results

• Who to call after the test or procedure if you have questions or problems

• How much you will have to pay for the test or procedure