Pleural Biopsy

Pleural biopsy is performed to determine the cause of an exudative, mononuclear, or lymphocytic-predominant pleural effusion when thoracentesis is not diagnostic.

The yield of percutaneous pleural biopsy is significantly higher for tuberculosis than it is for pleural cancers (1). Improved laboratory techniques, newer diagnostic tests for pleural fluid (eg, adenosine deaminase levels, interferon-gamma, polymerase chain reaction studies for suspected tuberculosis), and more widespread availability of thoracoscopy often obviate pleural biopsy.

Percutaneous pleural biopsy should be performed only by a pulmonologist or surgeon trained in the procedure and only in patients who are cooperative and have no coagulation abnormalities.

The technique for percutaneous pleural biopsy is essentially the same as that for thoracentesis and can be performed at the bedside; no specific additional patient preparation is necessary. Ultrasound or CT guidance is typically used (2, 3). At least 3 specimens obtained from one skin location, with 3, 6, and 9 o’clock positioning of the needle-cutting chamber, are needed for histology and culture.

Chest radiograph should be obtained after biopsy because of increased risk of complications, which are the same as those for thoracentesis but with higher incidence of pneumothorax and hemothorax (4, 5).