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Original Research: Disorders of the Pleura |

Physician-Based Ultrasound-Guided Biopsy for Diagnosing Pleural DiseaseSuccessful Ultrasound-Guided Biopsy by Physicians

Robert J. Hallifax, BMBCh; John P. Corcoran, BMBCh; Asia Ahmed, BMBCh; Myura Nagendran, BMBCh; Hussam Rostom, BMBCh; Neelam Hassan, BMBCh; Mahiben Maruthappu, BMBCh; Ioannis Psallidas, PhD; Ari Manuel, BMBCh; Fergus V. Gleeson, PhD, FCCP; Najib M. Rahman, PhD
Author and Funding Information

From the Oxford Centre for Respiratory Medicine (Drs Hallifax, Corcoran, Psallidas, Manuel, and Rahman), Oxford Respiratory Trials Unit (Drs Hallifax, Corcoran, Psallidas, Manuel, and Rahman), and Department of Radiology (Drs Ahmed and Gleeson), Churchill Hospital, Oxford; and the University of Oxford Clinical Medical School (Drs Nagendran, Rostom, Hassan, and Maruthappu), Oxford, England.

CORRESPONDENCE: Robert J. Hallifax, BMBCh, Oxford Respiratory Trials Unit, University of Oxford, Churchill Hospital, Oxford, OX3 7LJ, England; e-mail: robhallifax@yahoo.com


FUNDING/SUPPORT: This research was supported by the National Institute for Health Research Oxford Biomedical Research Centre, The Oxford University Hospitals Trust, University of Oxford.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;146(4):1001-1006. doi:10.1378/chest.14-0299
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BACKGROUND:  Definitive diagnosis of pleural disease (particularly malignancy) depends upon histologic proof obtained via pleural biopsy or positive pleural fluid cytology. Image-guided sampling is now standard practice. Local anesthetic thoracoscopy has a high diagnostic yield for malignant and nonmalignant disease, but is not always possible in frail patients, if pleural fluid is heavily loculated, or where the lung is adherent to the chest wall. Such cases can be converted during the same procedure as attempted thoracoscopy to cutting-needle biopsy. This study aimed to determine the diagnostic yield of a physician-led service in both planned biopsies and cases of failed thoracoscopy.

METHODS:  This study was a retrospective review of all ultrasound-guided, cutting-needle biopsies performed at the Oxford Centre for Respiratory Medicine between January 2010 and July 2013. Histologic results were assessed for the yield of pleural tissue, final diagnosis, and clinical follow-up in nonmalignant cases.

RESULTS:  Fifty ultrasound-guided biopsies were undertaken. Overall, 47 (94.0%) successfully obtained sufficient tissue for histologic diagnosis. Of the 50 biopsy procedures, 13 were conducted after failed thoracoscopy (5.2% of 252 attempted thoracoscopies over the same time period); of these 13, 11 (84.6%) obtained sufficient tissue. Thirteen of 50 biopsy specimens (26.0%) demonstrated pleural malignancy on histology (despite previous negative pleural fluid cytology), while 34 specimens (68.0%) were diagnosed as benign. Of the benign cases, 10 were pleural TB, two were sarcoidosis, and 22 were benign pleural thickening. There was one “false negative” of mesothelioma (median follow-up, 16 months).

CONCLUSIONS:  Within this population, physician-based, ultrasound-guided, cutting-needle pleural biopsy obtained pleural tissue successfully in a high proportion of cases, including those of failed thoracoscopy.

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