Closed Pleural Biopsy Research Articles

Non-specific pleuritis: long-term follow-up outcomes

ABSTRACT Background The definitive etiology of nonspecific pleuritis (NSP), the influence of the type of pleural biopsy on clinical results and the minimum duration of follow-up is controversial. Research design and methods A retrospective, observational study of patients ≥ 18 years with NSP confirmed by closed pleural biopsy (CPB), local anesthesia pleuroscopy (LAP), or video-assisted thoracic surgery (VATS). Results A total of 167 patients were included (mean follow-up, 14.4 months), of which 25 (15%) were diagnosed within one month; [15 (60%) malignant]. Of the remaining 142 pleural effusions (PEf), 69 (48.6%) were idiopathic; 49 (34.5%) not-malignant and 24 (16.9%) malignant (4 mesotheliomas and 20 metastasic). The diagnosis of NSP was established by CPB (7; median time to diagnosis, 9.4 months), LAT (5; 15.8 months), and VATS (8; 13.5 months) (p = 0.606). Sixty-eight patients (40.7%) died during follow-up (mean time, 12 months). Conclusions In a substantial percentage of patients diagnosed with NSP, a definitive diagnosis will not be obtained, a relevant number of patients will develop a malignant PEf. The diagnostic procedure used for the diagnosis of NSP does not seem to influence delay in the diagnosis of malignant PEf. The data obtained suggest that follow-up should be maintained for at least 24 months.

Study on the application of percutaneous closed pleural brushing combined with cell block technique in the diagnosis of malignant pleural effusion.

This study was to investigate the diagnostic value of percutaneous closed pleural brushing (CPBR) followed by cell block technique for malignant pleural effusion (MPE) and the predictive efficacy of pleural fluid carcinoembryonic antigen (CEA) for epidermal growth factor receptor (EGFR) mutations in lung adenocarcinoma patients with MPE. All patients underwent closed pleural biopsy (CPB) and CPBR followed by cell block examination. MPE-positive diagnostic rates between the two methods were compared. Univariate and multivariate analyses were performed to determine factors influencing the EGFR mutations. Receiver operating characteristic (ROC) curve was used to analyze the predictive efficacy of pleural fluid CEA for EGFR mutations. The cumulative positive diagnostic rates for MPE after single and twice CPBR followed by cell block examination were 80.5% and 89.0%, higher than CPB (45.7%, 54.3%) (P < 0.001). Univariate analysis showed that EGFR mutation was associated with pleural fluid and serum CEA (P < 0.05). Multivariate analysis showed that pleural fluid CEA was an independent risk factor for predicting EGFR mutation (P < 0.001). The area under the curve (AUC) of pleural fluid CEA for EGFR mutation prediction was 0.774, higher than serum CEA (P = 0.043), but no difference with the combined test (P > 0.05). Compared with CPB, CPBR followed by the cell block technique can significantly increase the positive diagnostic rate of suspected MPE. CEA testing of pleural fluid after CPBR has a high predictive efficacy for EGFR mutation in lung adenocarcinoma patients with MPE, implying pleural fluid extracted for cell block after CPBR may be an ideal specimen for genetic testing.

Study of comparison of medical thoracoscopic guided biopsy versus closed pleural biopsy for etiological diagnosis of undiagnosed exudative pleural effusions: A randomized controlled study

BackgroundMedical thoracoscopy (MT) has gained widespread acceptance in the diagnosis of undiagnosed exudative pleural effusions. In developing countries, including India medical thoracoscopy is not widely available. Aims1. To analyze the yield of closed pleural biopsy (CPB) in comparison with MT in the diagnosis of undiagnosed exudative pleural effusions. 2. Comparison of complications between CPB and MT. MethodologyThis was a prospective randomized controlled study conducted in a tertiary care centre, from January 2020 to September 2021. The patients with undiagnosed exudative pleural effusions were included in the study. The enrolled patients were randomized into two groups, group A and group B. Total of 38 patients were taken, 19 patients in each group. Group A was subjected to MT. Group B was subjected to CPB with cope's needle. Ultrasound was used to mark the site of pleural effusion. ResultsDiagnostic yield was 78.9% in both MT and CPB group. CPB was significantly less painful procedure compared to MT. The duration of hospital stay was also significantly less in CPB as compared to MT (P < 0.001). CPB was associated with 5.3% mortality and there was no mortality in MT group. ConclusionsOur study recommends that, in the era of medical thoracoscopy, closed pleural biopsy still holds a significant role in the diagnosis of undiagnosed exudative pleural effusions especially where prevalence of tuberculosis is high. It is also a cost effective approach in developing countries like India.

Diagnostic Yield of Closed Pleural Biopsy Using Cope’s Needle in the Diagnosis of Exudative Pleural Effusion

Introduction: The aetiology of pleural effusion may be difficult to diagnose based on the pleural fluid cytology, biochemical and microbiological study. Pleural biopsy using Cope’s needle may help in such cases where definitive diagnosis can not be achieved with the help of cytology. Aim: To make aetiological diagnosis of undiagnosed exudative cases using Closed Pleural Biopsy (CPB) and to determine the diagnostic yield of CPB taken by Cope’s needle in aetiologically confirmed exudative pleural effusion. Materials and Methods: This prospective observation study was conducted in Department of Pulmonary Medicine at Burdwan Medical College and Hospital, Burdwan, West Bengal, India, from April 2021 to March 2022 among 52 patients. Under local anaesthesia, diagnostic and therapeutic thoracocentesis were done. The pleural fluid was sent for complete biochemical, microbiological analysis, and cytology. Later, pleural biopsy was also done using Cope’s pleural biopsy needle. The variables studied were age, gender, pleural fluid cytology, pleural fluid for acid fast bacilli, Gram stain, and culture and pleural biopsy histopathology. Results: Out of 52 patients, 34 (65.4%) were males and 18 (34.6%) were females. The majority of the patients (41, 78.8%) had a right-sided pleural effusion. The mean value of lymphocytes and polymorphs count was 57.7% and 32.7%, respectively. Histopathology showed granulomatous inflammation compatible with tuberculosis in 18 (34.6%) patients, non-specific inflammation in 17 patients (32.7%), and 5 (9.6%) patients as adenocarcinoma. Squamous cell carcinoma was seen in 4 (7.7%), 2 (3.8%) showed undifferentiated carcinoma, while 6 (11.5%) samples had inadequate tissue for opinion. In 6 (11.5%) cases pleural tissue was inadequate to give any opinion. 5 (9.6%) cases showed adenocarcinomas, 2 (3.8%) cases showed squamous cell carcinoma and 4 (7.7%) cases showed undifferentiated carcinoma. The true positives were 18 and 11 for tuberculous and malignant pleural effusion, respectively. The diagnostic yield of pleural biopsy was found to be 75% in case of tubercular pleural effusion and 78.6% for malignant pleural effusion. Conclusion: This study suggests that tuberculosis and malignancy are the two common aetiologies for exudative pleural effusion. Pleural biopsy plays an additional role in histopathological confirmation of aetiologically diagnosed exudative pleural effusion.

Comparison between closed pleural biopsy and medical thoracoscopy for the diagnosis of undiagnosed exudative pleural effusions: a systematic review and meta-analysis.

BackgroundExudative pleural effusion (EPE) is a common diagnostic challenge. The utility of medical thoracoscopy (MT) and closed pleural biopsy (CPB) to aid in the diagnosis of EPE has been reported in many published studies. Herein, we perform a systematic review and meta-analysis to compare the diagnostic yield and safety of CPB and MT in EPE.MethodsFour databases were searched for studies reporting the diagnostic yield of CPB and MT for EPE. The quality of the included studies was evaluated according to the quality assessment of diagnostic accuracy studies (QUADAS) tool. The pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and complication risks were compared between the two groups.ResultsTen studies dealing with CPB and twenty-three studies dealing with MT for the diagnosis of EPE were included in this meta-analysis. Pooled sensitivity, specificity, PLR, NLR and DOR of CPB group was 77%, 99%, 32.55, 0.22, 165.71, respectively, while pooled sensitivity, specificity, PLR, NLR and DOR of MT group was 93%, 100%, 10.82, 0.08, 162.81, respectively. The area under the summary receiver operating characteristic (SROC) curve of CPB and MT were both 0.97. The ability of CPB to diagnose non-malignant diseases was like MT (69% vs. 68%), while the ability was lower than that of MT to diagnose malignant diseases (72% vs. 92%). The pooled diagnostic accuracy of CPB and MT for mesothelioma was 26% (95% CI, 14–38%) and 42% (95% CI, 22–62%) (P<0.001), respectively. The rate of complications with CBP was lower than that reported for MT.ConclusionsCBP is a relatively accurate tool with a lower complication rate compared to MT in the diagnosis of EPE, especially in diagnosing non-malignant diseases. We confirm the utility of MT in the diagnostic workup of malignancy (especially mesothelioma); however, in selected cases, CPB could be used as the first diagnostic approach with a favorable safety profile.

The diagnostic yield of closed needle pleural biopsy in exudative pleural effusion: a retrospective 10-year study.

BackgroundPleural effusion is a common presentation in clinical practice. About 40% of exudative pleural effusion is unable to be diagnosed through thoracentesis, and closed pleural biopsy (CPB) is needed. This study was designed to investigate the diagnostic yield of CPB in exudative pleural effusion.MethodsThis was a retrospective 10-year study of patients with unexplained exudative pleural effusion who underwent CPB in two centers. Malignant pleural effusion (MPE) was diagnosed when there was histopathological evidence of pleural tissue, pulmonary tissue, or pleural fluid. Tuberculous pleural effusion (TPE) was confirmed when granuloma or coagulative necrosis was observed in pleural tissue, Ziehl-Neelsen acid-fast staining was positive, or adenosine deaminase (ADA) in pleural effusion was higher than 35IU with clinical symptoms of TB orγ-interferon increased with symptoms of TB.ResultsA total of 644 patients were enrolled, of which 479 were specifically diagnosed (217 patients with TPE and 262 patients with MPE). The sensitivity of CPB in the diagnosis of MPE was 51.5%. Among the pathological types of MPE, lung adenocarcinoma accounted for 77.9% (204/262) of cases, making up the largest proportion. The sensitivity of CPB for diagnosing TPE was 68.7%.ConclusionsCPB has a relatively high sensitivity in the diagnosis of exudative pleural fluid, especially in relation to tuberculous lesions. CPB could provide an alternative technique in clinical practice, especially for basic hospital units without thoracoscopy.

Medical thoracoscopy and its evolving role in the diagnosis and treatment of pleural disease.

Establishing the etiology of exudative pleural effusions in the setting of an unrevealing pleural fluid analysis often requires biopsies from the parietal pleura. While closed pleural biopsy (CPB) has been a popular minimally-invasive approach, it has a poor diagnostic yield, barring a diagnosis of tuberculous pleurisy. Medical thoracoscopy (MT) is a minimally-invasive ambulatory procedure performed under local anesthesia or moderate sedation which allows for direct visualization of biopsy targets as well as simultaneous therapeutic interventions, including chemical pleurodesis and indwelling tunneled pleural catheter (ITPC) placement. The excellent yield and favorable safety profile of MT has led to it replacing CPB for many indications, particularly in the management of suspected malignant pleural effusions. As experience with MT amongst interventional pulmonologists has grown, there is an increased appreciation for its important role alongside percutaneous and surgical approaches in the diagnosis and treatment of pleural disease.

Accuracy of closed pleural biopsy in the diagnosis of malignant pleural effusion.

ABSTRACTObjective:Previous studies have demonstrated that closed pleural biopsy (CPB) has a sensitivity of less than 60% for diagnosing malignancy. Therefore, controversy has recently emerged regarding the value of CPB as a diagnostic test. Our objective was to assess the accuracy of CPB in diagnosing malignancy in patients with pleural effusion. Methods:This was a prospective 8-year study of individuals who underwent CPB to establish the etiology of pleural effusion. Information on each patient was obtained from anatomopathological reports and medical records. When CPB findings showed malignancy or tuberculosis, the biopsy was considered diagnostic, and that was the definitive diagnosis. In cases in which biopsy histopathological findings were nonspecific, a definitive diagnosis was established on the basis of other diagnostic procedures, such as thoracoscopy, thoracotomy, fiberoptic bronchoscopy, biochemical and cellular measurements in pleural fluid, and/or microbiological tests. The accuracy of CPB was determined with 2 × 2 contingency tables. Results:A total of 1034 biopsies from patients with pleural effusion were studied. Of those, 171 (16.54%) were excluded from the accuracy analysis either because of inadequate samples or insufficient information. The results of the accuracy analysis were as follows: sensitivity, 77%; specificity, 98%; positive predictive value, 99%; negative predictive value, 66%; positive likelihood ratio, 38.5; negative likelihood ratio, 0.23; pre-test probability, 2.13; and post-test probability, 82. Conclusions:CPB is useful in clinical practice as a diagnostic test, because there is an important change from pre-test to post-test probability.

A study to compare the diagnostic efficacy of closed pleural biopsy with that of the thoracoscopic guided pleural biopsy in patients of pleural effusion.

Background:The diagnostic approach to exudative pleural effusion remains an underappreciated aspect of modern thoracic medicine. 15-20% of the pleural effusions remain undiagnosed. The most efficient approach to pleural exudates remains uncertain and controversial particularly if acquisition of pleural tissue is required. The clinician needs to consider various factors when confronted with the choice between closed pleural biopsy (CPB) and thoracoscopy. Hence this study was planned to compare the diagnostic efficacy of CPB and Thoracoscopic pleural biopsy (TPB).Materials and Methods:This was a prospective interventional study in patients of exudative pleural effusion. CPB was performed by Cope's biopsy needle. Then inspection of the pleural cavity was performed by single port rigid thoracoscope (KARL, STORZ TELECAM DX II 20 2330 20) with viewing angle of zero (0) degrees and biopsy taken from the diseased or unhealthy parietal pleura. Accordingly we compared the results of CPB and TPB.Results:46 Patients underwent this study. In all 46 patients both CPB and TPB were performed. TPB was diagnostic in 36 cases (78.2%) while CPB was diagnostic only in 10 cases i.e. 21.7%. 10 (21,7%) cases remained undiagnosed. On thoracoscopic examination 30 patients were having nodularity, 25 (54.3%) were having adhesions and 20 (43.5%) were having hyperemia. 79.3% of the patients with nodularity turned out to be malignant and 71.4% of patients with adhesions and hyperemia tubercular.Conclusions:TPB has much greater diagnostic efficacy than CPB.

CT-guided biopsy versus conventional Abram’s needle biopsy in malignant pleural effusion

ObjectiveWe aimed to evaluate CT guided biopsy (CTGB) vs. standard closed pleural biopsy (CPB) in the histopathological diagnosis of the type of malignancy in patients with malignant pleural effusion. Patients and methodsWe studied 31 patients (21 male and 10 female) with malignant pleural effusion diagnosed by aspiration cytology and admitted to the medical ward of a general teaching hospital over a period of 1year. Patients were randomized into two groups: group 1 (n=16) underwent CTGB biopsy and group 2 (n=15) underwent Abram’s CPB. The diagnostic yield of both methods was compared. ResultsThe mean age of patients was 54±16years. History of smoking was obtained in 15 (48.4%) patients. Dyspnea was reported in 22 (71%) and chest pain in 15 (48.4%). Malignant pleural effusion was left-sided in 17 (54.8%), and massive in 21 (67.7%) patients. Of note, CT imaging revealed parietal pleura as a tumor site in 20 (64.5%) patients. Pathological diagnosis of the type of malignancy was achieved in 14 (87.5%) of group 1 using CTGB and 6 (40%) of group 2 patients using Abram’s CPB. The diagnostic value of CTGB was significantly higher than CPB (P=0.009). ConclusionCT-guided biopsy was found to be a reliable and safe method in the histopathological diagnosis of malignant pleural effusion. Its diagnostic potential was much superior to the standard closed pleural biopsy.

Diagnosis of exudative pleural effusion using ultrasound guided versus medical thoracoscopic pleural biopsy

IntroductionMedical thoracoscopy increases the diagnostic yield in patients with non-diagnosed pleural effusion when thoracocentesis and closed pleural biopsy (CPB) are non-diagnostic. Chest ultrasound (US) is a very useful imaging method for pleural diseases and the technique of ultra sound-guided cutting biopsy with a tru-cut needle has been well described. Aim of the workThe aim of this work was to diagnose exudative pleural effusion using ultrasound guided versus medical thoracoscopic pleural biopsy. Subjects and methodsForty patients with, non-diagnosed exudative pleural effusion admitted to the chest department, Alexandria university hospital, were enrolled after obtaining informed consents. All patients were subjected to; full history taking, thorough clinical examination, laboratory investigations including prothrombin activity and INR, biochemical, pathological and microbiological evaluation of the pleural aspirate and radiological evaluation. Then the patients were divided (randomly) into 2 groups each containing 20 patients. Pleural biopsies were performed using medical rigid thoracoscopy on group 1 and ultrasound guided tru-cut pleural biopsy on group 2. ResultsThe mean age in-group I was 55.0±13.05years and in-group II was 52.60±17.77years. There was no statistically significant difference between the two groups regarding age, sex, smoking, marital status and past medical conditions. There was no statistically significant difference between the two groups regarding radiological findings. There was no statistically significant difference between the two groups regarding the pleural fluid analysis. There was no statistically significant difference between the two groups regarding the gross pleural findings. In group II non- specific pleurisy was found in 5 (25.0%) patients (by thoracoscopy 1 of them was finally diagnosed as metastatic deposits from adenocarcinoma of unknown primary, one was confirmed to be tuberculous pleurisy and the remaining 3 cases were confirmed to be non- specific pleurisy). As regards complications in-group I, local wound infection occurred in 1 (5.0%) patient, and empyema occurred in 1 (5.0%) patient. In-group II, local wound infection occurred in 1 (5.0%) patient, and empyema occurred in 1 (5.0%) patient. ConclusionIt is better to use thoracoscopy in cases of undiagnosed exudative pleural effusion presented with a sufficient amount of pleural fluid to avoid lung injury while inserting the trocar. Whereas, ultrasound guided tru-cut pleural biopsy may be used in cases of undiagnosed exudative pleural effusion presented with thickened pleura but with an insufficient amount of pleural fluid.

Thoracic Ultrasound-Assisted Selection for Pleural Biopsy With Abrams Needle

Closed pleural biopsy (CPB) in patients with malignant pleural effusion is less sensitive than cytology. Ultrasound-assisted CPB allows biopsies to be performed in the lower thoracic parietal pleura, where secondary spread from pleural metastases is initially more likely to be found. We analyzed whether choosing the point of entry for CPB with thoracic ultrasound assistance influences the diagnostic yield in malignant pleural effusion. This prospective study included patients who underwent CPB performed by an experienced pulmonologist in 2008-2010 (group A) and thoracic ultrasound was used to select the biopsy site. The results were compared with a historical series of CPB performed by the same pulmonologist without the assistance of thoracic ultrasound (group B). An Abrams needle was used in all cases. We analyzed the obtaining of pleural tissue and the diagnostic yield. We included 114 CPBs from group A (23% tuberculous pleural effusion, 27% malignant pleural effusion) and 67 CPBs from group B (24% tuberculous pleural effusion, 30% malignant pleural effusion) (P = .70). Pleural tissue was obtained in 96.5% of the group A CPBs and 89.6% of the group B CPBs (P = .05). The diagnostic yields of CPB for tuberculous pleural effusion and malignant pleural effusion in group A were 89.5% and 77.4%, respectively, and 91.7% and 60%, respectively, in group B (P = .80 for tuberculous pleural effusion, and P = .18 for malignant pleural effusion). Selecting the point of entry for CPB using thoracic ultrasound increases the likelihood of obtaining pleural tissue and the diagnostic yield, but without statistical significance. We recommend ultrasound-assisted CPB to investigate pleural effusion, since the diagnostic yield of a pleural biopsy with an Abrams needle increased by > 17% in subjects with malignant pleural effusion.

Usefulness of fiberoptic pleuroscopy and brushing in patients with unknown pleural effusion

Background and ObjectivePleural fluid cytology (PFC) and closed pleural biopsy (CPB) are the two most commonly employed diagnostic tests for malignant pleural effusions. The aim of this study was to determine the benefit and safety of the fiberoptic pleuroscopy and brushing for the diagnosis of unknown pleural effusion. Patients and methodsTwenty patients with suspected malignant pleural effusion and negative cytology for malignancy underwent pleuroscopy with brushing using a 32Fr chest tube and a flexible fiberoptic bronchoscope for the diagnosis, inspection, and management of patients. All the samples were sent for bacteriological and cytolopathological studies. Patients had a mean follow-up period of 4.37±1.86months. ResultsSixteen cases were finally documented to have malignancy, (12 men and 4 women) aged 62.8±5.8years, while pleuroscopic biopsy provided diagnosis in 12 (75%) of 16 cases. Pleural brushing was diagnostic in 10 (62.5%) of 16 cases. in 2 of these 10 cases, pleuroscopic biopsy was negative. When all procedures were used in combination, the yield increased to 87.5%. When pleural brushing (PBR) was used in addition to pleural biopsy by fiberoptic bronchoscopy, the yield of the diagnosis increased more than 10%. No major complications were encountered with this method. There was no mortality due to these interventions. ConclusionFiberoptic pleuroscopy and brushing utilizing fiberoptic bronchoscopy through a chest tube is a relatively safe, simple and well-tolerated technique with a high diagnostic yield for patients with malignant pleural effusion.

To the Editor: Blind needle biopsy of the pleura: why not?

To the Editor: We read with great interest the excellent review by Janssen [1] in the September issue of the European Respiratory Review , where the author highlights the position of thoracoscopy in the current diagnostic armamentarium of pneumonology and nicely concentrates the up-to-date knowledge in the field. As a general comment, we would say that thoracoscopy is not a panacea for the diagnosis of pleural effusions; however, the value of blind needle biopsy of the pleura (or closed-pleural biopsy; CPB) may not actually be so limited. Thoracoscopy is essentially the best way to biopsy the pleura. However, not all diseases that affect the pleura can be diagnosed by pleural biopsy, even with the best techniques. The main histological abnormalities of the pleura that demonstrate disease specificity are those associated with malignant and granulomatous disorders, the most frequent representative of the latter disease category being tuberculosis (TB) [2, 3]. Thus, pleural biopsy (and thoracoscopy) can virtually diagnose two main disorders: malignant pleural effusions (MPEs) and TB pleuritis. In the case that the patient does not suffer from either of them, the pathologist will most probably diagnose “nonspecific pleuritis”. Although “not specific”, this diagnosis can exclude malignancy because of the high negative predictive value of thoracoscopy for MPEs [4]. This observation highlights …

Cryptococcal pleural effusion in acquired immune deficiency syndrome—Diagnosis by closed pleural biopsy

Summary Pulmonary cryptococcosis is usually diagnosed by detection of cryptococcal antigen or by culture from the pleural fluid or bronchoalveolar lavage fluid (BAL), or by histopathology of the lung biopsy specimen. Diagnosis of cryptococcal pleural effusion by closed pleural biopsy (CPB) has been reported only once [Katz AS, Niesenbaum L, Mass B. Pleural effusion as the initial manifestation of disseminated cryptococcosis in acquired immune deficiency syndrome. Diagnosis by pleural biopsy. Chest 1989;96:440–1]. We report another case where CPB confirmed the diagnosis of pleural cryptococcosis. This could be the first case where CPB and trans-bronchial lung biopsy (TBLB) in the same patient diagnosed pleural and pulmonary cryptococcosis, respectively. This case highlights that closed pleural biopsy is a useful test in the definitive diagnosis of cryptococcal pleural effusion.

Diagnostic Value of Medical Thoracoscopy in Pleural Disease: A 6-Year Retrospective Study

Unlike thoracocentesis and closed pleural biopsy (CPB), medical thoracoscopy permits biopsy with direct visualization. In a 6-year retrospective study of patients having undergone at least one medical thoracoscopy, we analyzed the diagnostic yield of thoracoscopy and its value in the management of pleural disease. From January 1, 1989, to December 31, 1994, 168 medical thoracoscopies were performed on 154 patients (123 men; mean age +/- SE, 61 +/- 1 years), of which 149 were diagnostic and 19 were indicated for therapeutic assessment in malignant mesothelioma (MM). Prior to thoracoscopy, at least one CPB had been performed in 120 of 149 cases, yielding a diagnosis in 96 cases. Thoracoscopy challenged the CPB-based diagnosis in 43 of 96 cases. In 66 cases of nonspecific inflammation diagnosed by CPB, thoracoscopy revealed MM in 16 cases, adenocarcinoma in 10 cases, undetermined carcinoma in 3 cases, and pleural tuberculosis in 3 cases. In 18 cases in which the CPB diagnosis was MM, thoracoscopy, performed for precise staging, challenged the diagnosis in 4 cases. In 12 cases of carcinoma diagnosed by CPB, thoracoscopy specified the histologic type in 7 cases. Thoracoscopic diagnoses were found to be erroneous in 10 of 149 cases, mainly owing to pleural adhesions that limited access to the pleural cavity. There was one thoracoscopy-related death, one case of sepsis, and six cases of empyema. Medical thoracoscopy appears to be efficient and relatively safe in the management of pleural disease. Pleural adhesions can lower its diagnostic value.

Yield of closed pleural biopsy and cytology in exudative pleural effusion.

Objective:To determine diagnostic yield of Closed Pleural Biopsy (CPB) and Cytology in Exudative Pleural Effusion (PE).Methods:This prospective comparative study was conducted at Chest Unit-II & Medical Unit-IV of Dow University of Health Sciences, Karachi Pakistan from January 2011 till December 2014.Results:Ninety-four patients with exudative PE were finally included. The mean age (SD) was 44.0 (13.8) years. Overall Specific Diagnosis was reached in 76/94 patients; 46 Tuberculosis PE (TPE) & 30 Malignant PE (MPE). CPB diagnosed all TPE patients alone and 28/30 of MPE. Cytology diagnosed only 10/30 patients of MPE with 8 patients having both CPB & Cytology positive for malignancy whereas in the remaining two cases only Cytology positive. The sensitivity of CPB in detecting TPE and MPE was 93.9% and 82.4% respectively whereas specificity for both was 100%. The diagnostic yield of cytology in detecting MPE is only (33.3%). The diagnostic yield of CPB for TPE and MPE is 100% and 93.3% respectively. The overall specific diagnostic yield of CPB is 78.7%.Conclusion:CPB is better than pleural fluid cytology alone with the later adding little to diagnostic yield when both combined in distinguishing TPE from MPE, the two main differential of exudative PE in a TB-Endemic country.