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.