Pleural biopsy is performed to determine the cause of undiagnosed exudative pleural effusion. We aimed to compare the diagnostic yield of blind pleural biopsy against that of image guided pleural biopsies for persistent undiagnosed exudative pleural effusions between 1996 and 2006 at our institution.
We identified patients who underwent blind and image guided pleural biopsies during the study period using surgical pathology and the hospital discharge database. Adequate specimen was defined as evidence of pleural tissue on two or more samples. Final diagnosis was recorded from detailed chart review.
A total of 174 pleural biopsy specimens were identified, of which 103 (59.1%) were closed. Among the 103 patients who underwent closed pleural biopsy, 93 (90.2%) had adequate specimens. 29/93 (31%) were diagnostic (Tuberculosis = 17, Carcinoma = 8, others = 4). Disease specific analysis showed a diagnostic sensitivity of 77% for tuberculosis (17/22) and 33% for malignancy (8/29). 42 patients had additional workup including VATS, and or CT guided biopsy. The sensitivity of image guided pleural biopsy at our institution was 68.4% (26/38). Disease specific analysis showed a diagnostic sensitivity of 80 % for tuberculosis and 73 % for malignancy.
Diagnostic yield of an initial adequate closed pleural biopsy at our institution is similar to previous reports. Image guided biopsy outperformed closed pleural biopsy in our study for the diagnosis of malignancy but not for tuberculosis.
Blind pleural biopsy continues to have a role in the diagnosis of tuberculosis but has a low yield for malignancy. The decision on which technique to use for diagnosis is dependent on disease prevalence and availability of requisite technology.
Muralikrishna Gopal, No Financial Disclosure Information; No Product/Research Disclosure Information