Needle biopsy of the pleura

Alternative names
Closed pleural biopsy; Pleural needle biopsy

The pleura is a thin membrane that lines the lungs and the inside of the chest wall. A pleural biopsy involves taking a sample of the pleural tissue to be examined under a microscope. The pleural needle biopsy is done under a local anesthetic.

How the test is performed

This test does not have to be done in the hospital. You will be sitting up for the biopsy. The skin at the biopsy site will be cleansed, and a local anesthetic will be injected into the skin and into the pleural membrane.

A larger, hollow needle is then inserted through the skin and into the chest cavity. The needle is rotated and, as it is taken out, tissue samples are collected. In general, three biopsy samples are taken. The site is then bandaged.

At various times during the procedure, you will be asked to sing, hum, or say “eee.” This helps prevent air from getting into the chest cavity, causing pneumothorax (lung collapse).

How to prepare for the test
Blood tests will be done before the biopsy, and a chest x-ray may also be taken. You must sign consent forms.

Infants and children:
The preparation you can provide for this test depends on your child’s age, previous experiences, and level of trust. For general information regarding how you can prepare your child, see the following topics:

  • Infant test or procedure preparation (birth to 1 year)  
  • Toddler test or procedure preparation (1 to 3 years)  
  • Preschooler test or procedure preparation (3 to 6 years)  
  • Schoolage test or procedure preparation (6 to 12 years)  
  • Adolescent test or procedure preparation (12 to 18 years)

How the test will feel
With the injection of the local anesthetic, there may be a brief prick and a burning sensation. When the biopsy needle is inserted, you may feel pressure. As the needle is being withdrawn, you may feel a tugging sensation.

Why the test is performed
Pleural biopsy is usually done to determine the cause of a persistent pleural effusion (collection of fluid around the lung) or other abnormality of the pleural membrane. Diseases that may be diagnosed by pleural biopsy include tuberculosis and cancer.

Normal Values
The pleural tissues appear normal, without evidence of inflammation, infection, or malignancy.

What abnormal results mean
The abnormal results may reveal cancer, tuberculosis, a viral disease, a fungal disease, a parasitic disease, or collagen vascular disease.

Additional conditions under which the test may be performed include:

  • Metastatic pleural tumor  
  • Primary lung cancer

What the risks are
There is a slight chance of the needle puncturing the wall of the lung, which can produce a partial collapse of the lung. This usually resolves on its own. There is a chance of excessive blood loss.

Special considerations

If a closed pleural biopsy is unsuccessful at making a diagnosis, surgical biopsy of the pleura may be required in some cases.

Johns Hopkins patient information

Last revised: December 6, 2012
by Simon D. Mitin, M.D.

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