Biopsy Specimens

A number of procedures can be undertaken to obtain pleural biopsies. A special needle, usually an Abrams or Cope needle may be used during thoracentesis, both to drain fluid and obtain a pleural biopsy. A pleural needle biopsy often provides insufficient tissue for diagnosis. When this is the case thoracoscopy and a visually directed pleural biopsy may be required. In some cases an open pleural biopsy is undertaken with or without decortication. Decortication is a procedure to remove constricting visceral pleural peel in order to expand the underlying lung. It is of use in very few patients as the morbidity and mortality usually outweigh any benefit. Approximately 10% of cases of malignant mesothelioma that have a biopsy will have seeding of the biopsy tract by tumour with subsequent chest wall recurrence. To prevent this happening radiation therapy is used on the biopsy site.

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