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Item ID: MON268   Source ID: 2

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by Julie J. Martin, MS

Anatomy and Physiology
The lungs are located in the chest cavity, a space enclosed by the breastbone in the front, the spine in the back, the diaphragm beneath, and 12 pairs of ribs and the muscles in between, curving around the sides.

The lungs share the chest cavity with the trachea, heart, esophagus, and many large and small arteries, veins, nerves, and lymph vessels.

Between the surface of the lungs and the chest wall are two layers of tissue called the pleura. One layer, the visceral pleura, is attached to the lung itself, while the other layer, the parietal pleura, is attached to the chest wall. A small amount of fluid in the space between the two layers allows the lungs to smoothly expand and contract with each breath. This area is called the pleural space.

Reasons for Procedure
Conditions affecting the lungs may occur deep inside the airways, in the tissue nearer to the surface, in the pleura or pleural space, or on the chest wall. Examples of these conditions include asthma, lung cancer, pneumonia, and chest injuries.

A transthoracic needle biopsy is used to obtain a sample of tissue from the lung or visceral pleura in order to diagnose disease.

Treatments
Doctors have a variety of ways to gather information about your lungs. Non-invasive imaging procedures, such as chest x-rays and CT scans, do not always provide enough information to make a diagnosis.

Other, more invasive tests, such as a bronchoscopy, are useful for diagnosing conditions that affect the trachea and large airways deep within the lungs.

A transthoracic needle biopsy is used to obtain a sample of tissue from the visceral pleura or inside the lung. The procedure involves inserting a needle between your ribs to reach the area of interest. A related procedure, called a thoracentesis, is used to obtain a sample of fluid that has accumulated in the pleural space.

Procedure
In the days leading up to your procedure: Arrange for a ride to and from the hospital and for some help at home afterwards. Your doctor may recommend temporarily discontinuing any medications, herbs, or dietary supplements you regularly take. Do not start taking any new medications, herbs, or dietary supplements without consulting your doctor. The night before, eat a light meal and do not not eat or drink anything after midnight. You may be given medications to suppress a cough or prevent other conditions that may interfere with the procedure. Your doctor may use various imaging techniques, such as a CT scan or ultrasound, to help him or her precisely locate the target of your biopsy and guide the insertion of the needle.

Your skin will be cleaned at the site where the needle is to be inserted just above one of your ribs. To help you relax, you may receive a mild sedative and a local anesthetic may be used to numb the area.

Your doctor may make a small incision in your skin where the needle will be inserted. Then, while you hold your breath and remain as still as possible, your doctor will insert the needle through your skin and chest wall. You may feel pressure and then a quick, sharp pain when the needle reaches the surface of your lung. Your doctor will quickly obtain the sample of fluid or tissue and withdraw the needle.

A typical procedure takes less than 30 minutes. Afterwards, a chest x-ray or other imaging technique will be used to make sure your lung has not collapsed.

Risks and Benefits
The risks associated with a transthoracic needle biopsy include: a collapsed lung, bleeding into the chest cavity, and/or infection.

Benefits of a transthoracic needle biopsy include: precise diagnosis of various lung conditions, such as cancer, reliable information to help plan treatment.

In a transthoracic needle biopsy, or any procedure, you and your doctor must carefully weigh the risks and benefits to determine whether it's the most appropriate procedure for you.

After the Procedure
After a transthoracic needle biopsy, the recovery time is usually very short. You will go home on the same day as the procedure unless there is a complication.

Contact your doctor immediately if you experience any of the following: signs of infection, such as fever and chills, bleeding from the needle insertion site, shortness of breath, severe chest pain, fast and/or irregular heartbeat, and/or lightheadedness or fainting.

Sources:

  • AllRefer.com. Medical tests & exams: Lung needle biopsy. 2003. Available at www.allrefer.com. Accessed August 13, 2004.
  • Busick, Natisha P., Peter C. Fretz, and Jeffrey R. Galvin, et al. Year. Transthoracic needle aspiration biopsy. Available on Virtual Hospital: a digital library of health information at www.vh.org. Accessed August 10, 2004.
  • Larscheid, Ryan C., Patricia E. Thorpe, and Walter J. Scott. 1999.
  • Percutaneous rransthoracic needle aspiration biopsy: A comprehensive review of its current role in the diagnosis and treatment of lung tumors.Lacasse, Yves, Eric Wong, Gordon H. Guyatt, and Deborah J. Cook. 1999.
  • Transthoracic needle aspiration biopsy for the diagnosis of localized pulmonary lesions: a meta-analysis. Thorax 54:884-893.Merck Manual of Diagnosis and Therapy. Percutaneous transthoracic needle aspiration; section 6 (Pulmonary disorders), chapter 65. Available at www.merck.com. Accessed August 11, 2004.
  • Merck Manual of Diagnosis and Therapy. Needle biopsy of the pleura or lung. Available at www.merck.com. Accessed August 11, 2004.


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