Pleural biopsy
During a pleural biopsy, doctors take a piece of tissue from the pleura so that it can be looked at under a microscope.
What is a pleura?
The lungs are covered by a lining (membrane) called the pleura. The pleura is made up of 2 layers:
- the inner layer covers the lungs
- the outer layer lines the ribcage and a sheet of muscle called the diaphragm – the diaphragm separates the chest from the tummy.
The space between the 2 layers is called the pleural cavity. The pleural cavity has a small amount of fluid in it. This fluid acts as a lubricant. This allows the lungs to move in and out smoothly so you can breathe easily.
What is a pleural biopsy?
During a biopsy, the doctor may remove a small piece of tissue so it can be looked at under a microscope. They may suggest a biopsy of the thickened pleura.
A pleural biopsy is more likely to confirm mesothelioma than a sample of fluid. A pleural biopsy can be taken in different ways.
- CT or ultrasound guided biopsy
- thoracoscopy.
What is a CT or ultrasound guided pleural biopsy?
A specialist doctor will give you a local anaesthetic to numb the area. They use an ultrasound or CT scan to help guide them to the right place. They pass a special type of needle through your skin into the thickened area. The needle has a tip that can cut out a small sample of tissue.
What is a thoracoscopy?
The doctor uses a thin tube (thoracoscope) to look at the pleura and the area around the lungs. They may also take biopsies.
You will have either a general anaesthetic, or a local anaesthetic with a sedative to make you sleepy. The specialist doctor makes a small cut in your chest wall. They then put the thoracoscope into your chest. The tube has a light and camera at the end, so the doctor can see into your chest. The doctor then drains any fluid and takes a biopsy.
Sometimes the doctor uses a video camera with the thoracoscope when taking biopsies. This is called video-assisted thoracoscopic surgery (VATS). It can help the doctor see the area around the lung more clearly and, if needed, do complex operations.
What is a talc pleurodesis?
After draining fluid or taking a biopsy, the doctor may put a sterile, medical grade talcum powder (talc) between the layers of the pleura. This helps prevent the fluid coming back. This is called talc pleurodesis. They put the talc through the tube in your chest and into the pleural space. This helps stick the 2 linings together, to help stop the fluid building up again.
Chest drain
A small, rubber tube may be left in place in your chest to drain any fluid and help your lung expand. This tube is usually removed after a few days.
Indwelling pleural catheter (IPC)
If your lung does not expand, doctors might leave a small tube inside the space between the pleura. It is about the size of a straw and is called an indwelling pleural catheter (IPC). You can open it at home to drain the fluid and prevent breathlessness.
After the biopsy
Having a biopsy can be uncomfortable but should not be painful. If you have any pain during or after the procedure, tell your doctor or nurse.
After the doctor has taken the biopsy, they will send it to the laboratory. A doctor who looks at cells or body tissue under a microscope to diagnose cancer (pathologist) will look at the biopsy.
Sometimes, even after taking a biopsy, the doctors may not be sure of the diagnosis. This is because it can be difficult to find the difference between mesothelioma and some other cancers and illnesses. If this happens, the samples may be sent to specialist laboratories to confirm the diagnosis. Sometimes you may need to have a test done again, or you may be referred to another hospital for a second opinion.
Related pages
About our information
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer.
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References
Below is a sample of the sources used in our mesothelioma cancer information. If you would like more information about the sources we use, please contact us at informationproductionteam@macmillan.org.uk
Kusamura S, Kepenekian V, Villeneuve L, Lurvink RJ, Govaerts K, De Hingh IHJT, Moran BJ, Van der Speeten K, Deraco M, Glehen O; PSOGI. Peritoneal mesothelioma: PSOGI/EURACAN clinical practice guidelines for diagnosis, treatment and follow-up. Eur J Surg Oncol. 2021 Vol, 47(1) pp6-59. [accessed April 2024].
Popat, S., Baas P., Faivre-Finn, C., Girard, N., Nicholson, A., Nowak, A., Opitz, I., Scherpereel, A, and Reck, M. 2021. ESMO Pleural mesothelioma guidelines. Malignant pleural mesothelioma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Available from: https://www.annalsofoncology.org/action/showPdf [accessed April 2024].
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