Diagnosis Of Pleural Lesions Research Articles

Diagnostic Yield and Safety of Image-Guided Pleural Biopsy: A Systematic Review and Meta-Analysis

Background: Diagnostic yield (DY) and safety of computed tomography (CT)- and thoracic ultrasound (TUS)-guided biopsies in the diagnosis of pleural lesions have been investigated in a number of studies, but no synthesis of data from the literature has ever been performed. Objectives: We aimed to provide the first systematic review and meta-analysis on the DY and safety of CT- versus TUS-guided biopsy in the diagnosis of pleural lesions. Method: We searched MEDLINE and EMBASE for all studies reporting outcomes of interest published up to April 2018. Two authors reviewed all titles/abstracts and retrieved selected full text to identify studies according to predefined selection criteria. Summary estimates were derived using the random-effects model. Cumulative meta-analysis assessed the influence of increasing adoption of the procedures over time. Results: Thirty original studies were included in the present review; the number of studies on TUS-guided biopsy was almost three-fold higher than those on CT-guided biopsy. The pooled DYs of the 2 procedures were overall excellent and differed <10%, being 84% for TUS-guided biopsy and 93% for CT-guided biopsy. Safety profiles were reassuring for both the techniques, being 7 and 3% for CT- and TUS-guided biopsy, respectively. DY of ultrasound technique significantly improved over time, while no time effect was observed for CT-guided biopsy. Conclusions: Data show that CT- and TUS-guided biopsies in the diagnosis of pleural lesions are both excellent procedures, without meaningful differences in DYs and safety. Considering that TUS is non-ionizing and easily performed at the bedside, it should be the preferred approach in presence of adequate skills.

Medical thoracoscopy versus image-guided pleural biopsy for diagnosing pleural diseases

Background The diagnostic role of medical thoracoscopy and image-guided pleural biopsy in patients with undiagnosed exudative pleural effusion has increased over the last few years. Objective The aim was to compare the efficacy and safety of medical thoracoscopy versus image-guided [ultrasound (US) and computed tomography] pleural biopsy in the diagnosis of pleural lesions. Patients and methods A total of 40 patients with undiagnosed pleural lesions were divided into two groups. After full investigations, pleural biopsies were taken by medical thoracoscopy and the image-guided technique in groups I and II, respectively. Results In group I, the results of 19 (95%) patients yielded a positive diagnosis, whereas in group II, the results of 17 (85%) patients yielded a positive diagnosis (where results were positive in 80% of US-guided biopsies and 90% in computed tomography-guided biopsies), with no significant difference in the diagnostic yield of the two groups. The US-guided biopsy showed significantly the least duration (P=0.001). Complications were significantly fewer in the image-guided biopsy group (P=0.008). The mean duration of hospital stay was significantly less in the image-guided group than in the medical thoracoscopy group (P=0.001). In conclusion, the overall diagnostic yield is comparably high for medical thoracoscopy and image-guided pleural biopsies, and both are complementary techniques used in different clinical situations. Each diagnostic procedure has its own advantages and disadvantages. Image-guided biopsy is less invasive and can be carried out as an outpatient procedure, whereas medical thoracoscopy provides diagnostic and therapeutic capabilities in one setting.

Medical thoracoscopic versus ultrasound guided transthoracic pleural needle biopsy in diagnosis of pleural lesions

BackgroundMedical thoracoscopy increases the diagnostic yield in patients with undiagnosed pleural effusion. Ultrasound guided pleural biopsies are safe procedures with high diagnostic yields. ObjectiveTo compare safety and efficacy of medical thoracoscopic versus ultrasound guided transthoracic needle biopsy in the diagnosis of pleural lesions. Patients and methods40 patients with undiagnosed pleural lesions were divided into 2 groups. After clinical, radiological examination and laboratory investigations; pleural biopsies were taken by ultrasound guided needle biopsy and medical thoracoscopy in group I and II respectively. ResultsComplications in group I were in the form of pain in 2 patients (10%), hemoptysis in 1 (5%), while complications in group II were pain in 4 (20%), failure of the lung to expand in 5 (25%), pneumothorax in 5 (25%) and wound infection in 3 patients (15%).Final histopathological diagnosis in group I was parapneumonic effusion in 3 patients (15%), inflammatory lung lesion in 1 (5%), pleural fibroma in 2 (10%), malignant mesothelioma in 4 (20%), sarcoma in 1 (5%), adenocarcinoma in 1 (5%), squamous cell carcinoma in 4 (20%), and metastatic adenocarcinoma in 1 (5%). Final histopathological diagnosis in group II was pleural TB in 4 patients (20%), inflammatory lung lesions in 2 (10%), malignant mesothelioma in 6 (30%), adenocarcinoma in 5 (25%), and metastatic adenocarcinoma in 2 (10%). The diagnosed cases were 17 (85%) and 19 (95%) in groups I and II respectively. ConclusionsMedical thoracoscopy is an important diagnostic method for the diagnosis of undiagnosed pleural effusion while it is concluded that US guided pleural biopsy is more useful in cases of pleural lesions without effusion.

Advances in Computed Tomography of the Thorax

Because of its enhanced density resolution, cross-sectional format, and ability to simultaneously evaluate lung, mediastinum, and chest wall, computed tomography has largely replaced conventional techniques in several clinical situations. The author discusses the CT detection of diseases such as lung nodules, mediastinal masses, and hilar lesions; CT's use as a screening technique; and its replacement of angiography in the evaluation of intrathoracic vascular lesions.

Case reports: pleural melioidosis.

We report herein a patient with pulmonary melioidosis, whose initial chest roentgenogram revealed only a pleural mass. The patient had not been in a zone endemic for melioidosis during the previous 15 months. We stress the importance of including melioidosis in the differential diagnosis of pleural lesions, and of considering this diagnosis in any patient who has been in an endemic zone at any time in the past.