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Needle Biopsy of the Pleura or Lung

By Noah Lechtzin, MD, MHS, Associate Professor of Medicine and Director, Adult Cystic Fibrosis Program, Johns Hopkins University School of Medicine

If thoracentesis does not uncover the cause of a pleural effusion (a fluid buildup in the space between the two layers of the pleura), a doctor may do a pleural biopsy. First, the skin is cleaned and anesthetized as for thoracentesis. Then using a larger cutting needle, a doctor takes a small sample of tissue from the pleura and sends it to a laboratory to be examined for signs of disorders, such as cancer or tuberculosis. About 80 to 90% of the time, a pleural biopsy is accurate in diagnosing tuberculosis, but it is less accurate for diagnosing cancer and other disorders.

If a tissue specimen needs to be obtained from a lung tumor, a doctor may do a needle biopsy. After anesthetizing the skin, a doctor, often using chest computed tomography (CT) or ultrasonography for guidance, directs a biopsy needle into a tumor and obtains cells or a small piece of tissue to be sent to the laboratory for analysis. If a lung infection is suspected, tissue can also be sent for culture (a procedure in which a tissue sample is placed in a container containing nutrients and the container is observed to detect bacterial growth). Complications of pleural and lung biopsies are similar to those for thoracentesis.