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

the removal of pleural tissue for histological examination after exudative fluid indicative of infection, neoplasm, or tuberculosis is obtained by thoracentesis or when a pleural-based tumor, reaction, or thickening is indicated by a chest x-ray.

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 ?
We here conduct pulmonary function test, ultrasound chest and guided procedures like pleural tap pleural biopsy, close and open lung biopsy which provides round-the-clock service to patients, said Dr.
He added that: "We here conduct pulmonary function test, ultrasound chest and guided procedures like pleural tap pleural biopsy, close and open lung biopsy which provides round-the-clock service to patients.
Whenever a pleural biopsy is done, tissue should be sent for TB culture smear and acid-fast bacilli (AFB) tests.
The patient was diagnosed with bilateral chylothorax and underwent blind pleural biopsy to rule out other aetiologies of persistent bilateral pleural effusion aside from KS-induced scarring of the thoracic duct.
The identification of features of malignancy in a desmoplastic mesothelioma requires adequate tissue, and the amount of tissue in a closed pleural biopsy is often insufficient.
In 1994, three diagnostic criteria were defined to confirm a myelomatous pleural effusion (6):(a) demonstration of a monoclonal protein in pleural fluid electrophoresis, (b) detection of atypical plasma cells in the pleural fluid, and (c) histologic confirmation with a pleural biopsy sample or by autopsy.
Additionally pleural biopsy excluded mesothelioma and pleural thickening secondary to asbestos exposure.
A diagnosis of tuberculosis required a confirmed culture of Mycobacterium tuberculosis in either sputum, pleural fluid or pleural biopsy.
Evaluation of exudative pleural effusion usually includes thorough history, complete clinical examination, appropriate blood tests, radiographs, studies of pleural fluid and needle biopsy of pleura using Abram's pleural biopsy needle or Cope's biopsy needle.
Thoracentesis and pleural biopsy often do not provide enough tissue to distinguish MME from adenocarcinoma and negative results of these test do not exclude the diagnosis.
However, thoracoscopic pleural biopsy is positive 80% of the time.
Remaining isolates were from bone biopsy samples (4%), pleural fluid (2%), pleural biopsy samples (2%), and stool samples (2%).