Response

Abstract

We thank Drs Thangakunam and Christopher for their letter in response to the AUDIO study.1Psallidas I. Kanellakis N.I. Bhatnagar R. et al.A pilot feasibility study in establishing the role of ultrasound-guided pleural biopsies in pleural infection (the AUDIO Study).Chest. 2018; 154: 766-772Abstract Full Text Full Text PDF PubMed Scopus (42) Google Scholar It is a great pleasure to know that physicians in different places in the world use pleural biopsy either through thoracoscopy or ultrasound-guided biopsies as a method to diagnose tuberculous pleuritis. In conditions such as malignant pleural effusion and tuberculous pleuritis, it is well recognized that pleural biopsy has a much higher yield than that obtained from fluid alone.2Hooper C. Lee Y.C. Maskell N. et al.Investigation of a unilateral pleural effusion in adults: British Thoracic Society Pleural Disease Guideline 2010.Thorax. 2010; 65: ii4-ii17Crossref PubMed Scopus (508) Google Scholar To our knowledge, no other studies have tested the use of pleural biopsies (either through medical thoracoscopy or ultrasound-guided techniques) in conventional bacterial pleural infection. The results of the AUDIO study1Psallidas I. Kanellakis N.I. Bhatnagar R. et al.A pilot feasibility study in establishing the role of ultrasound-guided pleural biopsies in pleural infection (the AUDIO Study).Chest. 2018; 154: 766-772Abstract Full Text Full Text PDF PubMed Scopus (42) Google Scholar suggested that ultrasound-guided pleural biopsies are safe and significantly improve diagnostic microbiologic yield compared with routine techniques in patients with bacterial pleural infection. The addition of pleural biopsies to blood and pleural fluid microbiologic analyses increased the diagnostic yield by 25%, and in these cases the pleural biopsy specimen was the only microbiologically positive sample obtained. The use of ultrasound-guided pleural biopsies in pleural infection was first evaluated in the AUDIO study, and the results highlight the feasibility, safety, and efficacy of this technique. Medical thoracoscopy is a common technique, although it is not routinely used for pleural infection in the United Kingdom, as it tends to be reserved for those who are suspected of having cancer. The authors’ suggestion of better microbiology yield of medical thoracoscopy compared with ultrasound-guided pleural biopsy has not yet been proven, but we agree it might provide larger biopsy specimens and thus even further increase diagnostic yield. Currently, a clinical study with the aim of evaluating whether hospitals are able to safely offer medical thoracoscopy to patients with pleural infection has just finished recruiting in the United Kingdom. We urge the authors to publish their data on the use of pleural biopsies in pleural infection, as this research may show further increases in diagnostic yield using either medical thoracoscopy or ultrasound-guided pleural biopsy methods. A Pilot Feasibility Study in Establishing the Role of Ultrasound-Guided Pleural Biopsies in Pleural Infection (The AUDIO Study)CHESTVol. 154Issue 4PreviewPleural infection is a common complication of pneumonia associated with high mortality and poor clinical outcome. Treatment of pleural infection relies on the use of broad-spectrum antibiotics because reliable pathogen identification occurs infrequently. We performed a feasibility interventional clinical study assessing the safety and significance of ultrasound (US)-guided pleural biopsy culture to increase microbiological yield. In an exploratory investigation, the 16S ribosomal RNA technique was applied to assess its utility on increasing speed and accuracy vs standard microbiological diagnosis. Full-Text PDF The Audio Study: Thoracoscopic Pleural Biopsy May Be Even BetterCHESTVol. 155Issue 3PreviewWe read with interest the article by Psallidas et al1 in a recent issue of CHEST (October 2018). We congratulate the authors for the novel idea of culturing the pleural tissue in bacterial empyemas. We would like to share our experience regarding microbiologic yield of pleural biopsy specimens in tubercular pleural effusions. Full-Text PDF