Pleural Biopsy

Assessment of pleural effusion does not reveal the etiology of pleural disease in many patients. Furthermore, many patients with pleural disease do not have pleural effusion. Thus, pleural biopsy is an essential step in diagnosing both malignant and benign diseases of the pleura. For the most part, the “blind” pleural biopsy has been replaced by image-guided procedures. Both computed tomography and ultrasonography can be used to target suspicious nodules and patchy and diffuse areas of pleural thickening. Cutting-needle biopsy is superior to fine-needle aspiration biopsy, but the two techniques can be complementary and may provide a higher diagnostic yield when used together. Image-guided pleural biopsies rarely result in serious complications, and minor complications either are self-limiting or can be easily managed.