Disorders of the Pleura |

The Role of Percutaneous Closed-Needle Pleural Biopsy in the Evaluation of Exudative Pleural Effusion FREE TO VIEW

Arshan Beyzaei-Arani, MD; Jalil Ahari, MD; Rahul Khosla, MD
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Washington DC VA Medical Center, Washington, DC

Chest. 2014;145(3_MeetingAbstracts):272A. doi:10.1378/chest.1824138
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SESSION TITLE: Pleural Disease/Pleural Effusion Posters

SESSION TYPE: Poster Presentations

PRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PM

PURPOSE: Several studies with wide range of diagnostic yield of closed needle pleural biopsy (CNPB) have been published in literature. CNPB is helpful in establishing diagnosis of malignant and tuberculous pleural effusions where conventional diagnostic modalities such as biochemical, cytological and microbiological data are unable to make a definitive diagnosis. CNPB may demonstrate granuloma in 50-80% of patients with tuberculous effusion. Diagnostic yield for malignant effusions ranges from 5-7% for mesotheliomas and 40-87% for other neoplasms. The aim of our study was to determine diagnostic yield of CNPB at our institution.

METHODS: A retrospective analysis of all CNPBs from 1990-2013 was conducted at the Washington DC VA Medical Center. 129 consecutive cases were identified. Pleural biopsy was obtained by Cope pleural biopsy needle. Pleural biopsies were subjected to histopathology and bacterial, mycobacterial and fungal cultures.

RESULTS: Age ranged from 37 to 91 years (mean 65.3 with SD of 11.19). Majority of patients were men (96.9%). Overall 8 biopsies were determined to have inadequate specimen (6%). There were 3 (2.3%) small pneumothoraces which did not require any intervention. There were 39 patients with a diagnosis of malignancy of which pleural biopsy was diagnostic in 18 cases (46.2%). Tuberculous effusion was diagnosed in 10 patients of which CNPB was diagnostic in 9 cases (90%). There was one case of sarcoidosis and one of disseminated cryptococcosis. The diagnostic sensitivity of CNPB for tuberculous effusion was 90%, specificity of 100%, positive predictive value of 100% and negative predictive value of 99.17%. The combined diagnostic yield of CNPB for tuberculous and malignant effusions was 20.9%.

CONCLUSIONS: CNPB is a safe technique with an overall diagnostic yield of 22.5% in our review. It has a very high diagnostic yield for tuberculous effusion (90%), and a reasonable yield for malignant effusion (46.2%).

CLINICAL IMPLICATIONS: For patients with undiagnosed exudative pleural effusion, CNPB should be considered as a diagnostic step in evaluation of those suspected of having tuberculous or malignant pleural effusions.

DISCLOSURE: The following authors have nothing to disclose: Arshan Beyzaei-Arani, Jalil Ahari, Rahul Khosla

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