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 pleura?

The lungs are covered by a lining (membrane) called the pleura, which has 2 layers. Between the 2 layers, in a space called the pleural cavity, is a small amount of fluid. This fluid acts as a lubricant. It allows the lungs to move in and out smoothly and helps you to breathe easily.

What is a pleural biopsy?

During a biopsy, a small piece of tissue is removed so that it can be looked at under a microscope. Your doctor may suggest a biopsy of the thickened pleura.

A pleural biopsy is more likely to confirm the diagnosis of mesothelioma than a sample of pleural fluid.

Your doctor may take a pleural biopsy in different ways:

  • CT or ultrasound guided biopsy
  • Thoracoscopy

What is a CT or ultrasound guided pleural biopsy?

A CT scan makes a three-dimensional (3D) picture of the inside of the body using x-rays taken by the CT scanner. An ultrasound scan uses sound waves to build up a picture of internal organs. It can also be used to guide a biopsy.

The 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. Then, 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?

A thoracoscopy lets the doctor look at the pleura and the area around the lungs using a thin tube (thoracoscope). 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 off any fluid and takes a biopsy.

Find out more about having a thoracoscopy.

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 from 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 removed after a few days.

Indwelling Pleural Catheter (IPC)

If your lung does not expand, the 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). This can be used 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 pleural mesothelioma and some other cancers and illnesses. If this happens, the biopsy 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.

About our information

  • References

    Below is a sample of the sources used in our mesothelioma information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk

    Woolhouse I et al. British Thoracic Society Guideline for the investigation and management of malignant pleural mesothelioma. Thorax. 2018.

    Thomas A et al. Mesothelioma. BMJ Best Practice. 2019.

    Baas P et al. Malignant pleural mesothelioma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up.  Annals of Oncology. 26 (Supplement 5): v31–v39. 2015. Available from: www.pubmed.ncbi.nlm.nih.gov/26223247

    Kusamara S et al. Peritoneal mesothelioma: PSOGI/EURACAN clinical practice guidelines for diagnosis, treatment and follow-up. European Journal of Surgical Oncology. March 2020.


  • Reviewers

    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. It has been approved by Senior Medical Editor, Dr David Gilligan, Consultant Clinical Oncologist.

    Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.