PURPOSE: The etiology of pleural effusions can be determined by simple thoracentesis. Occasionally, a pleural biopsy is needed to determine the cause of undiagnosed exudative pleural effusions. Pleural biopsy can be performed as a closed/blind, image guided or open surgical procedure. The diagnostic yield of a pleural biopsy depends upon the extent of the pleural involvement, prevalence of the disease, operator experience and use of image guidance. We aimed to determine the diagnostic yield of a blind pleural biopsy for persistent undiagnosed exudative pleural effusion during the period 1996 to 2006 at our institution.
METHODS: We identified patients who underwent blind pleural biopsy during the study period from our surgical pathology database. Data on fluid chemistry, cytology and microbiology were obtained from medical records review. Final diagnosis was recorded from detailed chart review. Adequate specimen was defined as evidence of pleural tissue on two or more samples. Patients undergoing pleural biopsy via image guidance (ultrasound and CT guided), VATS/ pleuroscopy and open pleural biopsy were excluded.
RESULTS: A total of 39 pleural biopsy specimens were identified from surgical database. Of which 2 (5.1 %) were open, 2 (5.1 %) were via VATS, 4 (10.2 %) were image guided, 31 (79.4 %) were closed. Among the 31 patients who underwent closed pleural biopsy, 29 had adequate specimens. 9/31 (29 %) were diagnostic (Tuberculosis= 5 (16% sensitivity), Carcinoma = 3 (9.6% sensitivity), Amyloidosis = 1). 20 patients had additional workup including VATS, and or CT guided biopsy. Almost all the exudative pleural effusions were diagnosed with further work-up, except two, in which the etiology remains unknown.
CONCLUSION: Diagnostic yield of an initial adequate closed pleural biopsy at our institution is similar to previous reports.
CLINICAL IMPLICATIONS: Pleural biopsy remains an important tool in the investigation of undiagnosed exudative pleural effusion. However, with improved and readily available imaging techniques, the utility of closed pleural biopsy remains questionable in institutions with limited number of closed pleural biopsies.
DISCLOSURE: Muralikrishna Gopal, None.