Closed Pleural Biopsy and Fluid Cytology in the Diagnosis of Suspected Pulmonary Cancer with Pleural Involvement

Abstract

In a retrospective study of 44 cases of suspected primary pulmonary cancer with pleural involvement, the diagnostic value of pleural biopsy a.m. Abrams was evaluated. Biopsy specimens in 20 patients showed malignancy, which in 16 cases provided an adequate diagnosis, while 4 patients needed pleural biopsy by means of operation. In a total of 24 cases showing biopsy specimens without malignancy there were 4 false-negative ones. Among the patients under study, closed pleural biopsy combined with pleural fluid cytology proved malignancy in 96% of the cases in which neoplastic disease of the lungs and pleura was otherwise diagnosed. These findings indicate the value of using both fluid cytology and closed pleural biopsy at an early stage of the diagnostic procedure in cases of suspected pulmonary cancer with pleural involvement.

Fibreoptic bronchoscopy in the management of lone pleural effusion: a negative study

“…Higher diagnostic yields are usual when multiple fluid specimens are examined [9]. The combined techniques give a diagnosis in approximately 90% of cases with malignant pleural effusions, particularly if repeat specimens of fluid and biopsies are obtained (8,(10)(11)(12)(13)(14). This was also the case in this study, in which two patients were positive for malignant cells and three were positive on pleural biopsy for malignancy on repeat examination following bronchoscopy.…”

Invasive Procedures in the Diagnosis of Pleural Disease

“…Repeat cytologic examination at the time of pleural biopsy provides an improved diagnostic yield in malignancy. 15,18,21,22 Potential complications with closed pleural biopsy are numerous and cover the spectrum from site pain to empyema ( Table 2). All adverse effects can be minimized if meticulous technique is employed.…”

“…Mestitz et al 3 Hampson and Karlish 7 Hanson and Phillips 6 Levine et al 20 Scerbo et al 14 Salyer et al 18 Von Hoff and LiVobsi 16 Frist et al 15 Winkleman and Pfistzer 17 Larson and Axelson 21 Mungall et al 11 Liss 19 Poe et al 13 Prakash and Relman 12 Total *TB: tuberculosis from biopsies obtained as close to the diaphragm as possible. Increasing the number of biopsy sites at one sitting does not appear to increase the diagnostic yield in either tuberculous pleurisy or malignancy.…”

Regular review: The pleural cavity

“…This identifies 75% of cases of tuberculosis 25. The technique is also useful if malignancy is suspected,26 and, combined with cytology, 90% of cases will be diagnosed 27. If mesothelioma is suspected video assisted thoracoscopic surgery may be a more useful technique 28…”