Diagnostic yield and safety of closed needle pleural biopsy in exudative pleural effusion

Abstract

Background: Closed pleural biopsy was previously considered a procedure of choice in cases of undiagnosed pleural effusion with good efficacy. Currently, the closed pleural biopsy has been replaced by thoracoscopic biopsy but not easily available in resource-limited setups. Objective: The objective of this study was to analyze the diagnostic yield and safety of closed needle pleural biopsy in exudative pleural effusion and assessment of patients' characteristics with the yield of pleural biopsy. Design: This was a cross-sectional study. Settings: This study was conducted at Institute of Respiratory Diseases, SMS Medical College, Jaipur, a tertiary care center of West India. Patients and Methods: A total of 250 cases of pleural effusion were evaluated with complete pleural fluid biochemical, microbiological, and cytological examination. Out of these 250 patients, 59 were excluded from the study as the diagnosis could be established on initial pleural fluid examination. The remaining (191) patients were considered for closed pleural biopsy with Abrams pleural biopsy needle. Main Outcome Measures: The main outcome measure was diagnostic yield in the form of confirming diagnosis. Results: Out of the 191 patients with exudative lymphocytic pleural effusion, 123 (64.40%) were diagnosed on the first pleural biopsy. Among the remaining 68 patients, 22 patients had repeat pleural biopsy with a diagnostic yield of 59.9%. The overall pleural biopsy could establish the diagnosis in 136 (71.20%) patients with pleural effusion. The most common diagnosis on pleural biopsy was malignancy followed by tuberculosis. Conclusions: Closed pleural biopsy provides diagnostic yield nearly comparative to thoracoscopy in properly selected patients of pleural effusions. In view of good yield, low cost, easy availability, and very low complication rate, it should be used routinely in all cases of undiagnosed exudative lymphocytic pleural effusion. Limitations: There was no comparison with a similar group undergoing thoracoscopic pleural biopsy.

Keywords

Closed pleural biopsy - malignant pleural effusion - thoracoscopic pleural biopsy - tubercular pleural effusion

Publication History

Article published online:
09 August 2021

• References

• 1 Poe RH, Israel RH, Utell MJ, Hall WJ, Greenblatt DW, Kallay MC. Sensitivity, specificity, and predictive values of closed pleural biopsy. Arch Intern Med 1984;144:325-8.
• 2 Suri JC, Goel A, Gupta DK, Bhatia A. Role of serial pleural biopsies in the diagnosis of pleural effusions. Indian J Chest Dis Allied Sci 1991;33:63-7.
• 3 Kettel LJ, Cugell DW. Pleural biopsy. JAMA 1967;200:317-20.
• 4 Tomlinson JR, Sahn SA. Invasive procedures in the diagnosis of pleural disease. Semin Respir Med 1987;9:30-6.
• 5 Hooper C, Lee YC, Maskell N; BTS Pleural Guideline Group. Investigation of a unilateral pleural effusion in adults: British Thoracic Society pleural disease guideline 2010. Thorax 2010;65 Suppl 2:ii4-17.
• 6 Chakrabarti B, Ryland I, Sheard J, Warburton CJ, Earis JE. The role of Abrams percutaneous pleural biopsy in the investigation of exudative pleural effusions. Chest 2006;129:1549-55.
• 7 Basu A, Chakrabarti I, Ghosh N, Chakraborty S. A clinicopathological study of tuberculous pleural effusion in a tertiary care hospital. Ann Trop Med Public Health 2012;5:168-72.
• 8 Levine H, Cugell DW. Blunt-end needle biopsy of pleura and rib. Arch Intern Med 1962;109:516-25.
• 9 Antunes G, Neville E, Duffy J, Ali N; Pleural Diseases Group, Standards of Care Committee, British Thoracic Society. BTS guidelines for the management of malignant pleural effusions. Thorax 2003;58 Suppl 2:ii29-38.
• 10 Viskum K, Enk B. Complications of thoracoscopy. Poumon Coeur 1981;37:25-8.