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Pleural Biopsy

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

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Pleural biopsy is done to determine the cause of an exudative pleural effusion when thoracentesis is not diagnostic.

The yield of closed pleural biopsy is about twice as high for TB than it is for pleural cancers. Improved laboratory techniques, newer diagnostic tests for pleural fluid (eg, adenosine deaminase levels, interferon-gamma, PCR studies for suspected TB), and more widespread availability of thoracoscopy have made the procedure less necessary and therefore uncommonly done.

Percutaneous pleural biopsy should be done only by a pulmonologist or surgeon trained in the procedure and should be done only in patients who are cooperative and have no coagulation abnormalities. Technique is essentially the same as that for thoracentesis and can be done at the bedside; no specific additional patient preparation is necessary. 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 x-ray should be done after biopsy because of increased risk of complications, which are the same as those for thoracentesis but with higher incidence of pneumothorax and hemothorax.