Ultrasound guided closed pleural biopsy versus medical thoracoscopic pleural biopsy in diagnosis of pleural diseases

Abstract

BackgroundThe diagnostic approach to pleural disease remains an underappreciated aspect of modern thoracic medicine, despite the fact that pleural disease affects approximately 300 subjects per 100,000 population per year worldwide. Tissue biopsies required for diagnosis can be obtained by various methods; blind pleural biopsy, guided biopsy, medical thoracoscopic or surgical pleural biopsy. Aim of the workTo compare the diagnostic efficiency, reliability, complications and advantages of transthoracic ultrasound guided (TUS) pleural biopsies with those of medical thoracoscopic pleural biopsies in patients with pleural diseases. Patients and methodsThis study included 71 patients with pleural disease. All patients were subjected to complete history taking, full clinical examination, CT chest, TUS examination with TUS guided biopsies for legible cases and medical thoracoscopic biopsies for legible cases. The patients included in the study were classified according to the procedure by which pleural biopsy was divided into 3 groups: Group 1 (39 patients underwent medical thoracoscopic pleural biopsies alone), Group 2 (10 patients underwent TUS pleural biopsies alone), Group 3 (22 patients underwent pleural biopsies by both techniques). The patients included in the study were classified according to the pathology of the lesions into Group A (51 patients with malignant lesions) and Group B (included 20 patients with non-malignant lesions). The malignant patients included in the study were classified according to the pathology of the lesions into Group A1 (24 patients with primary malignant lesions) and Group A2 (27 patients cases with secondary malignant lesions). ResultsTUS guided pleural biopsies had a sensitivity of 77.78% and diagnostic accuracy of 81.25%; while medical thoracoscopic pleural biopsies had a sensitivity of 94% and a diagnostic accuracy of 95.08%. ConclusionBoth TUS guided pleural biopsy and medical thoracoscopic pleural biopsy are available to diagnose different pleural lesions each of which has its advantages and disadvantages. The proper selection of the patients for each modality will result in raising the diagnostic yield of both modalities. TUS examination before medical thoracoscopy will allow proper selection of patients, reduce incidence of complications, guide for the best site of entry and raisethe diagnostic yield of medical thoracoscopy.