pleural biopsy

Pleural Biopsy

 

Definition

The pleura is the membrane that lines the lungs and chest cavity. A pleural biopsy is the removal of pleural tissue for examination.

Purpose

Pleural biopsy is done to differentiate between benign and malignant disease, to diagnose viral, fungal, or parasitic diseases, and to identify a condition called collagen vascular disease of the pleura. It is also ordered when a chest x ray indicates a pleural-based tumor, reaction, or thickening of the lining.

Precautions

Because pleural biopsy is an invasive procedure, it is not recommended for patients with severe bleeding disorders.

Description

Pleural biopsy is usually ordered when pleural fluid obtained by another procedure called thoracentesis (aspiration of pleural fluid) suggests infection, signs of cancer, or tuberculosis. Pleural biopsies are 85-90% accurate in diagnosing these diseases.
The procedure most often performed for pleural biopsy is called a percutaneous (passage through the skin by needle puncture) needle biopsy. The procedure takes 30-45 minutes, although the biopsy needle itself remains in the pleura for less than one minute. This type of biopsy is usually performed by a physician at bedside, if the patient is hospitalized, or in the doctor's office under local anesthetic.
The actual procedure begins with the patient in a sitting position, shoulders and arms elevated and supported. The skin overlying the biopsy site is anesthetized and a small incision is made to allow insertion of the biopsy needle. This needle is inserted with a cannula (a plastic or metal tube) until fluid is removed. Then the inner needle is removed and a trocar (an instrument for withdrawing fluid from a cavity) is inserted to obtain the actual biopsy specimen. As many as three separate specimens are taken from different sites during the procedure. These specimens are then placed into a fixative solution and sent to the laboratory for tissue (histologic) examination.

Preparation

Preparations for this procedure vary, depending on the type of procedure requested. Pleural biopsy can be performed in several ways: percutaneous needle biopsy (described above), by thoracoscopy (insertion of a visual device called a laparoscope into the pleural space for inspection), or by open pleural biopsy, which requires general anesthesia.

Aftercare

Potential complications of this procedure include bleeding or injury to the lung, or a condition called pneumothorax, in which air enters the pleural cavity (the space between the two layers of pleura lining the lungs and the chest wall). Because of these possibilities, the patient is to report any shortness of breath, and to note any signs of bleeding, decreased blood pressure, or increased pulse rate.

Risks

Risks for this procedure include respiratory distress on the side of the biopsy, as well as bleeding, possible shoulder pain, pneumothorax (immediate) or pneumonia (delayed).

Normal results

Normal findings indicate no evidence of any pathologic or disease conditions.

Abnormal results

Abnormal findings include tumors called neoplasms (any new or abnormal growth) that can be either benign or malignant. Pleural tumors are divided into two classifications: primary (mesothelioma), or metastatic (arising from cancer sites elsewhere in the body). These tumors are often associated with an accumulation of fluid between the pleural layers called a pleural effusion, which itself may be caused by pneumonia, heart failure, cancer, or blood clot in the lungs (pulmonary embolism).
Other causes of abnormal findings include viral, fungal, or parasitic infections, and tuberculosis.

Resources

Books

Pagana, Kathleen Deska. Mosby's Manual of Diagnostic and Laboratory Tests. St. Louis: Mosby, Inc., 1998.

pleural biopsy

A 'blind' percutaneous biopsy of the pleura, often performed in tandem with thoracentesis to determine the cause of pleural effusions, which may be due to bacterial or TB infection or malignancy–eg, adenocarcinomas and mesotheliomas Contraindications Low platelet count, especially < 20,000/mm3, and low fluid volume
References in periodicals archive ?
Despite repeated thoracentesis and closed pleural biopsy, diagnosis remains uncertain in 20% PE patients.1 When thoracentesis and closed pleural biopsy are inadequate for diagnosis, the next option in the diagnostic algorithm in exudative PE with a high suspicion index for malignancy is thoracoscopic approach.2-4 Despite thoracoscopic biopsy, specific diagnosis cannot be achieved in some patients.
Inclusion criteria was symptoms such as low fever and night sweat in the afternoon, moderate or large amount of pleural effusion confirmed by CT examination and chest color Doppler ultrasonography, a large number of lymphocytes in the pleural effusion laboratory examination, tuberculosis foci in the lung, positive anti-organic nuclear antibody test result, positive tuberculin test result and tuberculosis characteristics changes in pleural biopsy or pleural biopsy.
The diagnostic workup of exudative pleural effusions may require pleural biopsy for histopathological assessment in order to reach a diagnosis.
During this admission, a pleural biopsy was performed by the cardiothoracic surgeons.
If not yielding, invasive procedures like thoracoscopy and pleural biopsy are done.
Lot 1: accessories for fujifilm bronchial echo-endoscope; lot 2: transbronchial puncture needle under echo endoscope; lot 3: transbronchial aspiration needle; lot 4: lung biopsy forceps; lot 5: boutin-type pleural biopsy trocar; lot 6: castelain-type pleural biopsy trocar; lot 7: joly drainage catheter; lot 8: guilbout type drainage catheter; lot 9: thoracic drainage system
On the other hand, most exudative pleural effusions are difficult to diagnose and need initial thoracentesis followed by a series of biochemical, cytological and microbiological investigations and in some cases, it requires use of special diagnostic techniques such as computed tomography (CT) scan of thorax, pleural biopsy, bronchoscopy, and thoracoscopy.
Lymph node biopsy and pleural biopsy were suggestive of granulomatous disease, without signs of malignancy, leading to a diagnosis of sarcoidosis 1 month later (Fig.
A and B, Fake fat in a pleural biopsy from a patient with effusion and fibrosis (hematoxylin-eosin, original magnifications X40 [A] and X100 [B]).
Pleural biopsy is usually not needed for diagnosis, but the presence of classic rheumatoid nodules on the pleura is pathognomonic for RA [1, 2].
60 8 F chest tube insertion ([pi]) 6 14 F chest tube insertion 4 >14 F chest tube insertion ([dagger]) 8 Thoracentesis 26 Indwelling pleural catheter (IPC) insertion 3 IPC removal ([OMEGA]) 1 Pleuroscopy (with and without pleural biopsy) 3 IBV[R] valve insertion ([beta]) 3 VATS assisted bleb resection ([DELTA]) 3 Surgical decortication 3 Complications--no.
Following diagnostic thoracentesis and closed pleural biopsy (CPB), up to 25 percent of patients remain undiagnosed [1, 2].