PURPOSE: Recently there has been some controversy about the value of percutaneous closed pleural biopsy (PCPB) as a diagnostic procedure in pleural effusion. Our objective was to assess the accuracy of percutaneous closed pleural biopsy in patients with pleural effusion.
METHODS: We performed an ambispective study of all individuals who underwent PCPB, using Cope needle or Abram’s needle in order to establish the etiology of pleural effusion, during a 8/year period in a refering hospital of respiratory diseases in Mexico City. The identification of patients who underwent PCPB was obtained from the anatomopathological registries. The information of each patient was obtained by medical record review. In this study, when the pleural biopsy did not establish the definite diagnostic, we used as a gold standard other procedures such as thoracoscopy, open lung/pleural biopsy, fiberoptic bronchoscopy, adenosine deaminase and/or microbiological tests. With 2x2 table we determined the accuracy of PCPB.
RESULTS: A total of 1103 pleural biopsies were performed in 1034 patients. 583 (52.85%) biopsies were diagnostic. Malignancy was identified in 448 (40.62%) of whom 230 (20.85%) had adenocarcinoma and 102 (9.25%) mesothelioma. Tuberculosis 120 (10.88%)cases, other diagnostics 15 (1.36%). 436 (39.53%) biopsies were non/specific inflammatory. 175 (15.87%) were excluded to the analysis due to 84 (7.61%) obtaining no pleural tissue and in 91 (8.25%) we can not obtain case information. A total of 928 biopsies were analysed to asses the accuracy. Sensitivity = 72.12% CI 95% (69.24%-75.01%)Specificity = 95.89% CI 95% (94.61%-97.17%)Positive predictive value = 98.95% IC 95% (98.29%-99.60%)Negative predictive value = 39.11% IC 95% (35.97%-42.25%)Prevalence = 84.27% IC 95% (81.92%-86.61%)Likelihood ratio positive = 17.54 Likelihood ratio negative = 0.29 Pre/test odds = 5.36Post/test odds = 94Post/test probability = 98%.
CONCLUSION: The percutaneous closed pleural biopsy in this setting is useful in our practice due to produces big change from pre-test to post-test probability.
CLINICAL IMPLICATIONS: This is a valid, accurate and precise diagnostic test which can be applied in patients with pleural effusion for establishing a diagnostic of cancer or tuberculosis.
DISCLOSURE: Renata Báez-Saldañ a, No Financial Disclosure Information; No Product/Research Disclosure Information