Given the high prevalence of tuberculosis (TB) in our community we are still relying heavily on closed pleural biopsy (CPB) when encountered with an exudative pleural effusion. The diagnostic yield of CPB as opposed to thoracoscopic pleural biopsy is generally considered poor for malignancy and usually is not performed as an initial procedure when cancer is suspected. The objective of this study is to evaluate the diagnostic yield of CPB for cancer in our population.
Retrospective review of closed pleural biopsies performed between May, 1999 and April, 2003 at Harlem Hospital.
Total of 20 pleural biopsies were performed. Males were 14 and females 6.African-American were 16, Hispanics 3 and 1 patient was white. Smokers were 60 %( 12/20) of patients. HIV infection was documented at the time of the study in only 20 %( 4/20). All effusions were lymphocytic predominant exudate. The biopsy was diagnostic in 55% (11/20) and the diagnosis of cancer was made in 35 %( 7/20) while in 20 %( 4/20) tuberculosis was diagnosed. Fluid cytology was positive in only 20% (4/20). No major or minor complication was reported.
CPB is a safe procedure with a high diagnostic yield when used in hospital with the spectrum of diseases seen in this community.CLINICAL IMPLICATION: CPB is a safe procedure with good diagnostic yield. Physicians should have low threshold for utilizing it in inner city hospital serving population similar to our population in order to avoid more invasive procedures even when the suspicion of TB is not high.
S. Dogra, None.