A pleural biopsy is a diagnostic procedure used to obtain a small sample of the pleura, the thin tissue layers lining the lungs and chest cavity. This procedure is essential for diagnosing pleural diseases such as infections, inflammation, and cancers like mesothelioma or metastatic lung cancer.

There are several methods for performing a pleural biopsy. A needle biopsy involves inserting a needle through the chest wall, usually guided by imaging techniques such as ultrasound or CT scans, to accurately target the pleural tissue. Another method, thoracoscopic pleural biopsy, uses a thoracoscope—a thin, flexible tube with a camera and light—inserted through a small incision between the ribs, allowing direct visualization and sampling of the pleura.

The procedure is typically performed under local anesthesia and sedation, ensuring patient comfort. The obtained tissue sample is then examined under a microscope to detect abnormalities. Pleural biopsy is crucial for accurate diagnosis, guiding appropriate treatment plans, and improving patient outcomes by identifying the underlying cause of pleural effusions or other pleural abnormalities.

Causes:

• Diagnostic Purposes: When other diagnostic tests, such as imaging studies (chest X-ray, CT scan) or thoracentesis (pleural fluid aspiration), do not provide a definitive diagnosis, a pleural biopsy may be necessary to identify the underlying cause of pleural abnormalities.
• Suspicion of Pleural Diseases: When there is a suspicion of infectious, inflammatory, or neoplastic (cancerous) conditions affecting the pleura, a biopsy may be performed to confirm the diagnosis and guide treatment decisions.

Risk Factors:

• Underlying Medical Conditions: Individuals with pre-existing lung diseases, such as lung cancer, mesothelioma, tuberculosis, or pleural infections, may be at higher risk for complications during pleural biopsy.
• Coagulation Disorders: Patients with bleeding disorders or those taking anticoagulant medications may be at increased risk of bleeding complications during the biopsy procedure.
• Pleural Adhesions: Prior surgeries or inflammatory conditions may lead to the formation of pleural adhesions, making the biopsy procedure technically challenging and increasing the risk of complications.
• Pulmonary Hypertension: Elevated blood pressure in the pulmonary arteries (pulmonary hypertension) may increase the risk of bleeding during the biopsy procedure.
• Age: Advanced age may be associated with an increased risk of complications due to age-related changes in organ function and decreased physiological reserves.

Treatments:

• Diagnostic Confirmation: A pleural biopsy provides tissue samples for histopathological examination, allowing for the definitive diagnosis of pleural diseases, such as mesothelioma, metastatic cancer, tuberculosis, or inflammatory conditions like sarcoidosis or rheumatoid arthritis.
• Guidance for Treatment: The biopsy results help guide treatment decisions, including the initiation of appropriate therapies such as chemotherapy, radiation therapy, or surgery, depending on the underlying condition.
• Complications Management: In the event of biopsy-related complications, such as bleeding or pneumothorax (collapsed lung), prompt recognition and management are essential. This may include supportive measures, such as chest tube insertion to drain air or fluid from the pleural space or blood transfusions for severe bleeding.
• Pain Management: Some individuals may experience discomfort or pain at the biopsy site following the procedure. Pain medications and supportive care measures, such as rest and positioning, can help alleviate symptoms.