(Biopsy-Pleural, Percutaneous Pleural Biopsy)

Procedure Overview

What is a pleural biopsy?

A biopsy is a procedure performed to remove tissue or cells from the body for examination under a microscope. A pleural biopsy is a procedure in which a sample of the pleura (the membrane that surrounds the lungs) is removed with a special biopsy needle or during surgery to determine if disease, infection, or cancer is present.

There are three types of pleural biopsies:

  • Needle biopsy - After a local anesthetic is given, the physician inserts the special biopsy needle into the pleural space (the space between the pleura and the chest wall) to obtain a sample. Ultrasound (high-frequency sound waves) or computed tomography (CT scan, a combination of X-rays and computer technology) may be used to guide the biopsy needle insertion. Most pleural biopsies are performed using this technique. This procedure may also be referred to as a thoracentesis.

  • Thoracoscopic biopsy - A special type of endoscope (thin, flexible, lighted tube) is inserted into the pleural space under either local or general anesthesia. Through the endoscope, the physician is able to visualize the pleural tissue and take a biopsy of any suspicious tissue.

  • Open biopsy - After a general anesthetic is given, the physician makes an incision in the skin and surgically removes a piece of the pleura. Depending upon the lab findings, further surgery may be performed.

Other related procedures that may be used to help diagnose lung problems include chest X-ray, chest fluoroscopy, CT scan of the chest, bronchoscopy, bronchography, chest ultrasound, lung biopsy, lung scan, mediastinoscopy, positron emission tomography (PET scan), pulmonary angiogram, pulmonary function tests, and thoracentesis. Please see these procedures for additional information.

Anatomy of the respiratory system

The respiratory system is made up of the organs involved in the interchanges of gases, and consists of the:

  • Nose

  • Pharynx

  • Larynx

  • Trachea

  • Bronchi

  • Lungs

The upper respiratory tract includes the:

  • Nose

  • Nasal cavity

  • Ethmoidal air cells

  • Frontal sinuses

  • Maxillary sinus

  • Larynx

  • Trachea

The lower respiratory tract includes the lungs, bronchi, and alveoli.

What are the functions of the lungs?

The lungs take in oxygen, which cells need to live and carry out their normal functions. The lungs also get rid of carbon dioxide, a waste product of the body's cells.

The lungs are a pair of cone-shaped organs made up of spongy, pinkish-gray tissue. They take up most of the space in the chest, or the thorax (the part of the body between the base of the neck and diaphragm).

The lungs are enveloped in a membrane called the pleura.

The lungs are separated from each other by the mediastinum, an area that contains the following:

  • The heart and its large vessels

  • Trachea (windpipe)

  • Esophagus

  • Thymus

  • Lymph nodes

The right lung has three sections, called lobes. The left lung has two lobes. When you breathe, the air enters the body through the nose or the mouth. It then travels down the throat through the larynx (voice box) and trachea (windpipe) and goes into the lungs through tubes called main-stem bronchi.

One main-stem bronchus leads to the right lung and one to the left lung. In the lungs, the main-stem bronchi divide into smaller bronchi and then into even smaller tubes called bronchioles. Bronchioles end in tiny air sacs called alveoli.

Reasons for the Procedure

Reasons for which a pleural biopsy may be performed include, but are not limited to, the following:

  • To evaluate an abnormality of the pleura seen on chest X-ray

  • To diagnose the cause of a pleural infection (caused by bacteria, virus or fungus) or other condition

  • To investigate pleural effusion - fluid collection in the pleural space

  • To determine if a pleural mass is malignant (cancerous) or benign

  • To obtain further information after pleural fluid analysis suggests the presence of cancer, tuberculosis,or other infection

There may be other reasons for your physician to recommend a pleural biopsy.

Risks of the Procedure

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