Accuracy of closed pleural biopsy in the diagnosis of malignant pleural effusion

Abstract

Objective:Previous studies have demonstrated that closed pleural biopsy (CPB) has a sensitivity of less than 60% for diagnosing malignancy. Therefore, controversy has recently emerged regarding the value of CPB as a diagnostic test. Our objective was to assess the accuracy of CPB in diagnosing malignancy in patients with pleural effusion. Methods:This was a prospective 8-year study of individuals who underwent CPB to establish the etiology of pleural effusion. Information on each patient was obtained from anatomopathological reports and medical records. When CPB findings showed malignancy or tuberculosis, the biopsy was considered diagnostic, and that was the definitive diagnosis. In cases in which biopsy histopathological findings were nonspecific, a definitive diagnosis was established on the basis of other diagnostic procedures, such as thoracoscopy, thoracotomy, fiberoptic bronchoscopy, biochemical and cellular measurements in pleural fluid, and/or microbiological tests. The accuracy of CPB was determined with 2 × 2 contingency tables. Results:A total of 1034 biopsies from patients with pleural effusion were studied. Of those, 171 (16.54%) were excluded from the accuracy analysis either because of inadequate samples or insufficient information. The results of the accuracy analysis were as follows: sensitivity, 77%; specificity, 98%; positive predictive value, 99%; negative predictive value, 66%; positive likelihood ratio, 38.5; negative likelihood ratio, 0.23; pre-test probability, 2.13; and post-test probability, 82. Conclusions:CPB is useful in clinical practice as a diagnostic test, because there is an important change from pre-test to post-test probability.

Comparison between closed pleural biopsy and medical thoracoscopy for the diagnosis of undiagnosed exudative pleural effusions: a systematic review and meta-analysis

“…The search and selection flow diagram of studies on CPB and MT are shown in Figures 1 and 2, respectively. For CPB, our initial database search yielded a total of 446 citations (Figure 1) from which 10 studies on CPB ultimately met our inclusion criteria and were selected for meta-analysis (2,7,(12)(13)(14)(15)(16)(17)(18)(19); for MT, our initial database search yielded a total of 571 citations (Figure 2) from which 23 studies on MT ultimately met our inclusion criteria and were selected for meta-analysis (1,8,. Tables 1 and 2 show the basic features of the studies selected for analysis as well as their QUADAS scores.…”

Diagnostic Contribution of Closed Needle Pleural Biopsy – A 10-Year Retrospective Analysis

“…Nonspecific inflammation with varying degrees of fibrosis or normal pleura was found in 68% in one study (18). Several studies have highlighted the accuracy of needle biopsy in the diagnosis of malignant pleural effusion (2,5,26). The accuracy of needle biopsy in malignant pleural effusion was estimated to be high by this study because a large proportion were histological confirmed, and repeat biopsy is emphasized which increased the diagnostic contribution above all in malignant tumors.…”

Prospective Study of the Utility of Computed Tomography Triage of Pleural Biopsy Strategies in Patients With Pleural Diseases

“…Previous reports have suggested that the NPVs and −LRs of the needle biopsies are not reliable. 30 In our 2 previous randomized trials, the results were pooled according to the biopsy method used; the diagnostic sensitivity, specificity, PPV and NPV, and −LR are shown in the Table 5. 9,10 Patients were randomized to CT-ANPB versus MT, CT-ANPB versus US-CNPB, irrespective of CT findings in these studies.…”