What are the other Names for the Procedure?
- Fine Needle Aspiration Biopsy of Pleura
- Pleural Aspiration Needle Biopsy
- Pleural Core Biopsy
What is Pleural Needle Biopsy surgical procedure?
- Pleural Needle Biopsy is a minimally invasive procedure. During this procedure, a biopsy of the pleural tissue is performed to evaluate pleural abnormalities, such as a pleural mass, a pleural thickening, and for any other abnormalities that affects pleural function
- The procedure is conducted to sample abnormal pleural tissue, which is then examined to detect the presence of abnormalities
What part of the Body does the Procedure involve?
The Pleural Needle Biopsy usually involves the pleura; pleurae are linings that cover the lungs.
Why is the Pleural Needle Biopsy surgical procedure Performed?
The Pleural Needle Biopsy procedure is performed to analyze a mass, abnormal thickening in the pleura, such as a cyst in the lung, or to evaluate abnormal functioning of the pleura.
The procedure is one of the most important methods used in diagnosing any disease of the pleura, including pleural cancer (called mesothelioma), pleural infection, and pleural fibrosis
What are some Alternative Choices for the Procedure?
- The Pleural Needle Biopsy can be performed using fine needle aspiration (FNA) technique, using a core biopsy technique, and occasionally, the biopsy can performed using an open biopsy technique, wherein the chest is opened to take out a portion of pleura for analysis
- Generally, the biopsy is performed with help of either ultrasound or CT scan techniques. Open lung biopsy is an invasive technique that does not use either a CT scan, or an ultrasound technique
What are the Recent Advances in the Procedure?
Pleural Needle Biopsy is a simple and standard technique. The recent advances in the procedure are related to the manufacturing processes of the aspiration needle.
What is the Cost of performing the Pleural Needle Biopsy surgical procedure?
The cost of Pleural Needle Biopsy procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.
In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.
When do you need a Second Opinion, prior to the Procedure?
- It is normal for a patient to feel uncomfortable and confused by the information regarding Pleural Needle Biopsy and on what needs to be done
- If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required
- Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently
What are some Helpful Resources?
Prior to Pleural Needle Biopsy surgical procedure:
How is the Pleural Needle Biopsy surgical procedure Performed?
- The procedure is usually performed using ultrasound technique or CT scan of chest, depending on the reason for performing the pleural biopsy
- During a Pleural Needle Biopsy procedure, a very fine and hollow needle is inserted, where the mass or abnormality is noticed
- If the mass is a collection of fluid (such as loculated pleural effusion), then the fluid contained within the cyst is withdrawn. If the mass is a tumor, the needle may have to be inserted many more times, to remove a small amount of a tissue for pathological examination. If infection is suspected, then the fluid is sent to a laboratory for microbiological cultures
- The extracted sample is sent for further pathological examination, by a pathologist
- After the procedure, a little pressure is applied to the point where the needle was inserted and the spot bandaged
- The needle biopsy can be of two broad types, which are:
- Fine needle aspiration biopsy (FNAB)
- Core needle biopsy (CNB)
- In fine needle aspiration (FNA) biopsy, a small amount of tissue is aspirated and smeared on a glass slide. This glass slide is later examined by a pathologist under a microscope. Fine needle aspiration can be performed on a cyst, or on a solid mass
- In core needle biopsy (CNB), a hollow needle is inserted into the area of interest and cylindrical cores of the tissue are removed. The thin cylindrical tissue cores are then processed in the laboratory, to be examined by a pathologist. Core needle biopsy is usually performed on a solid mass
Where is the Procedure Performed?
The Pleural Needle Biopsy is usually performed in a physician’s clinic/office or a hospital. Normally, the individual can go home, once the procedure is completed.
Who Performs the Procedure?
The Pleural Needle Biopsy is performed by a trained physician or a radiologist.
How long will the Procedure take?
The biopsy procedure may take anywhere between 30-60 minutes.
What do you need to tell your Physician before the Procedure?
It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the Pleural Needle Biopsy procedure and helps avoid unnecessary complications.
- Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
- If you are allergic to any specific medication or food items
- If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
- If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
- If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
- If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
- If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
- A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.
What Preparations are needed, prior to Procedure?
The following steps may be performed prior to Pleural Needle Biopsy procedure:
- The physician may evaluate the individual’s medical history to gain information related to the overall health status including the medications that are being currently taken
- Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
- Normally local anesthesia is used; hence, do inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
- Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
- It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
- Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
- The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
- For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines
What is the Consent Process before the Procedure?
A physician will request your consent for the Pleural Needle Biopsy procedure using an Informed Consent Form.
Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.
You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.
What Tests are needed, before the Pleural Needle Biopsy surgical procedure?
Before the Pleural Needle Biopsy procedure, the following tests may be recommended:
- The physician may conduct a physical examination
- Some blood tests may be necessary prior to the procedure. The exact blood tests that are required shall be determined by the physician
- Additional radiological procedures, such as ultrasound, CT scan of chest, x-ray of chest, and MRI of lungs (which shows pleural abnormalities), may be performed
What are some Questions for your Physician?
Some of the basic questions that you might ask your physician are as follows:
- What is a Pleural Needle Biopsy?
- Why is this procedure necessary?
- What does the procedure involve?
- How will this procedure help?
- How soon should I get it done? Is there an emergency?
- Who are the medical personnel involved in this procedure?
- Where is the procedure performed?
- What are the risks while performing the procedure?
- What are the possible complications that might take place after the procedure, during recovery?
- How long will it take to recover? When can I resume normal work?
- How many such procedures have you (the physician) performed?
- What are the costs involved?
During the Pleural Needle Biopsy surgical procedure:
What kind of Anesthesia is given, during the Procedure?
- Usually no general anesthesia is required during the biopsy procedure; however, in almost all cases, local anesthesia may be administered
- During an Open Pleural Biopsy, general anesthesia is given
How much Blood will you lose, during the Procedure?
There is little or no blood loss involved, since the Pleural Needle Biopsy is a less-invasive procedure. However, during an open lung biopsy, the blood loss may be moderate.
What are the possible Risks and Complications during the Pleural Needle Biopsy surgical procedure?
There are general factors that increase the risk of getting complications during Pleural Needle Biopsy procedure and they include:
- Obesity: Generally greater the degree of obesity, greater is the surgical risk
- Smoking: Longer the smoking history (in pack years smoked), greater the surgical risk
- Advancing age
- Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
- Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
- Poorly functioning liver, as evidenced by increased blood liver function tests
- Hypertension (increased blood pressure), especially if it is poorly controlled
- Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
- Poor lung function, as evidenced by abnormal lung function tests
- History of bleeding disorders
- Longstanding illness, such as autoimmune disorders, chronic infections
- Poor immune system due to a variety of causes
The possible risks or complications that may arise during the biopsy are:
- Allergic reaction to the anesthetic medication used
- Syncope (fainting), due to vasovagal response
- Rarely, collapsed lung (pneumothorax) may occur during the procedure
What Post-Operative Care is needed at the Healthcare Facility after the Pleural Needle Biopsy surgical procedure?
At the healthcare facility, generally there is no requirement for any post-procedure care, unless any complications arise.
After the Pleural Needle Biopsy surgical procedure:
What are the possible Risks and Complications after the Pleural Needle Biopsy surgical procedure?
Post Pleural Needle Biopsy procedure, the following complications may arise:
- The patient may experience a hematoma (collection of blood under the skin) at the site
- Pain at the biopsy site
- Sometimes, an infection may develop at the point, where the needle was inserted for aspiration
- Rarely, pneumonia (infection of lungs) and collapsed lung (pneumothorax) may be complications
What is the Prognosis after the Surgery?
- The prognosis is usually excellent after a Pleural Needle Biopsy and there are no side effects
- However, there might be a small bruise at the location of needle insertion, causing soreness, for a day or two
When do you need to call your Physician?
Do contact your physician if you notice any of the following symptoms:
- Pain around the surgical wound
- Swelling and redness
- Bleeding or fluid drainage around the spot
- Chest pain
- Difficulty in breathing
- Excessive coughing, blood in cough
What Post-Operative Care is needed at Home after the Pleural Needle Biopsy surgical procedure?
At home, the following post-operative care is recommended, after a Pleural Needle Biopsy procedure:
- Wash the site of aspiration with soap
- Remove the bandage after 1-2 days
- Resume daily activities, as early as possible
- Avoid taking drugs that are not prescribed
- Do not take prescription pain-killers longer than prescribed
How long does it normally take to fully recover, from the Procedure?
The Pleural Needle Biopsy is a simple and less invasive procedure. It usually does not require any recovery time; a day of rest is usually sufficient.
What happens to tissue (if any), taken out during the Procedure?
- The tissue is taken for further examination and later disposed, as per the standard medical procedure.
- If the mass is a cyst, then the fluid contained within the cyst is withdrawn
- If the mass is a tumor, the needle may have to be inserted many more times, to remove a small amount of a tissue for pathological examination
- If infection is suspected as a cause for the cyst, then the fluid is sent to a laboratory for microbiological cultures
When should you expect results from pathologist regarding the tissue taken out, during the Procedure?
- The tissue removed is processed in the laboratory under a pathologist's supervision
- Slide(s) are prepared once the tissue is processed and this is examined by a pathologist and a pathology report issued
- Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time
Who will you receive a Bill from, after the Pleural Needle Biopsy surgical procedure?
It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.
Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:
- The physician’s office or hospital
- A family physician or a general surgeon
- A pathologist
- A radiologist
The patient is advised to inquire and confirm the type of billing, before the Pleural Needle Biopsy procedure is performed.
Thanks and Gratitude:
We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.
Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA