Role of Pleural Biopsy in the Etiologial Diagnosis of Exudative Pleural Effusion

Abstract

SESSION TITLE: Procedures: Pleura SESSION TYPE: Original Investigation Poster PRESENTED ON: Saturday, April 16, 2016 at 11:45 AM - 12:45 PM PURPOSE: Etiological diagnosis of exudative pleural effusion is sometimes difficult despite cytological, biochemical and microbiological tests. Aim of present study was to make an etiological diagnosis of exudative pleural effusion by pleural biopsy. METHODS: This observational study was performed from January 2012 to December 2014 in the Department of Internal Medicine and Pulmonology of BIRDEM General Hospital, Dhaka, Bangladesh. A total of 51 patients with exudative pleural effusion in whom the diagnosis was uncertain after routine biochemical, cytological and microbiological evaluation of pleural fluid were included in the study. These patients underwent pleural biopsy by Abram’s needle and histopathology was done to determine the etiology of pleural effusion. RESULTS: Out of 51 patients, most (38, 74.5%) were male. Majority (27, 52.9%) had right sided pleural effusion. Pleural fluid was straw color in 38 (74.5%) and hemorrhagic in 13 (25.5%) cases. Histopathology report of the pleural biopsy showed granulomatous inflammation compatible with tuberculosis (TB) in 15 (29.4%), metastatic carcinoma in 10 (19.6%), chronic inflammation in 9 (17.6%) and no abnormality in 17 (33.3%) cases. Among 10 cases of metastatic carcinoma, most (7, 70%) were adenocarcinoma. Mean value of pleural fluid protein (59.1 vs 47.2), adenosine deaminase (ADA) level (39.0 vs 15.6) and lymphocyte count (94.4% vs 68.3%) were all significantly raised in TB compared to metastatic carcinoma [p < 0.005]. CONCLUSIONS: Pleural biopsy was definitive diagnostic in almost half the patients with exudative pleural effusion. Pleural fluid protein, ADA and lymphocyte count are significantly raised in TB compared to malignancy. CLINICAL IMPLICATIONS: Pleural biopsy might be an investigation of choice for undiagnosed exudative pleural effusion. DISCLOSURE: The following authors have nothing to disclose: Jamal Ahmed, Mohammad Hossain, Muhammad Rahim, AKM Musa No Product/Research Disclosure Information