Closed Pleural Biopsy is Still Useful in the Evaluation of Malignant Pleural Effusion

Abstract

Background:Pleural fluid cytology for malignant cells is the easiest way to diagnose malignant pleural effusion with good sensitivity and specificity. With the introduction of medical thoracoscopy, the use of closed pleural biopsy for the diagnosis of cytology negative malignant pleural effusion is gradually decreasing. However use of thoracoscopy is limited due to its high cost and procedure related complications.Aims:The aim was to assess the usefulness of closed pleural biopsy in the diagnosis of malignant pleural effusion.Materials and Methods:Sixty-six patients of pleural effusion associated with malignancy were selected from the patients admitted in the chest ward of a tertiary care hospital over a period of 1 year. Pleural fluid aspiration for cytology and closed pleural biopsy were done in all the patients.Results:Out of 66 patients, 46 (69%) patients showed malignant cells in pleural fluid cytology examination. Cytology was positive in 35 (52%), 10 (15%), and 1 (1.5%) patients in the first, second, and third samples respectively. Closed pleural biopsy was positive in 32 (48%) patients. Among them, 22 also had positive cytology. Additional 10 cytology negative patients were diagnosed by pleural biopsy. Cytology–histology concordance was seen in 12 patients. Definite histological diagnosis could be achieved in five patients with indeterminate cytology. Pleural biopsy was not associated with any major postoperative complication.Conclusion:Closed pleural biopsy can improve the diagnostic ability in cytology negative malignant pleural effusion. Closed pleural biopsy has still a place in evaluation of malignant pleural effusion especially in a resource-limited country like India.

Clinical Profile of Malignant Pleural Effusions in a Tertiary Care Centre

“…Yield of fluid cytology also depends on the underlying primary tumour, sample preparation and experience of the cytologist. (11) In the current study pleural fluid cytology was positive in 62% cases, which is similar to the previous observations. In cases where pleural metastasis occurs, there is tumour cell seeding of the mesothelial surface of pleura.…”

“…This was comparable to what has been published earlier by Bhattacharya et al, which also showed a 54% adenocarcinoma diagnosis among cytology positive malignant effusions. (11) Zay Soe et al in their study reported a positivity in pleural fluid cytology of 64.4%. However, the commonest diagnosis for them was metastatic large cell carcinoma.…”

Role of Blind Closed Pleural Biopsy in the Management of Pleural Exudates

“…Edmondstone et al (32) and McLean et al (33) reported slightly lower diagnostic sensitivities of 60% and 62%, respectively. On the other hand, in another four series, the sensitivity varied between 43.8% and 48.5% (3,10,34,35). These data are important is assessing the improvement in the diagnostic sensitivity of the cytology that BCPB provides, which was 15% in our series, and would have avoided one pleuroscopy for every seven BCPB that were performed -figures slightly lower than those obtained in a review on this topic (an improvement of 19.4%, and the need for 5.2 BCPB to avoid one pleuroscopy) (36).…”

Clinical profile of lung cancer in rural medical college of Maharashtra (India): a prospective study of three years

“…Closed pleural biopsy was positive for malignancy in cases where pleural fluid cytology was negative. Chang and associates [33] performed thoracocentesis, closed pleural biopsy and bronchoscopy in 140 patients with pleural effusions. The combination of these procedures resulted in diagnosis in 100 (71%) of the patients: 68 patients were diagnosed by thoracocentesis or pleural biopsy or both; bronchoscopy provided diagnosis in additional 32 patients.…”