Is There a Role for a Needle Thoracoscopic Pleural Biopsy under Local Anesthesia for Pleural Effusions?

Abstract

BackgroundA closed pleural biopsy is commonly performed for diagnosing patients exhibiting pleural effusion if prior thoracentesis is not diagnostic. However, the diagnostic yield of such biopsies is unsatisfactory. Instead, a thoracoscopic pleural biopsy is more useful and less painful.MethodsWe compared the diagnostic yield of needle thoracoscopic pleural biopsy performed under local anesthesia with that of closed pleural biopsy. Sixty-seven patients with pleural effusion were randomized into groups A and B. Group A patients were subjected to closed pleural biopsies, and group B patients were subjected to pleural biopsies performed using needle thoracoscopy under local anesthesia.ResultsThe diagnostic yields and complication rates of the two groups were compared. The diagnostic yield was 55.6% in group A and 93.5% in group B (p<0.05). Procedure-related complications developed in seven group A patients but not in any group B patients. Of the seven complications, five were pneumothorax and two were vasovagal syncope.ConclusionNeedle thoracoscopic pleural biopsy under local anesthesia is a simple and safe procedure that has a high diagnostic yield. This procedure is recommended as a useful diagnostic modality if prior thoracentesis is non-diagnostic.

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

“…Previous studies on the performance of CPB in diagnosing malignancy, whether addressing CPB alone or comparing it with image-guided or medical thoracoscopy-guided techniques, have demonstrated that CPB with Cope or Abrams needles allows the diagnosis of 21% to 62% of cases of neoplasm-related pleural effusion 1 , 8 - 12 , 14 , 15 ( Table 5 ). When pleural biopsy is performed under image guidance, whether ultrasound or computed tomography, it consistently shows better performance, with sensitivity between 77% and 87.5%, 1 , 11 , 13 , 16 , 17 and when there is pleural thickening greater than 1 cm, sensitivity increases to 95%, a value similar to that achieved when biopsy is obtained with thoracoscopy.…”

“…Medical thoracoscopy and video-assisted thoracoscopy are considered the gold-standard methods of obtaining biopsies in cases of neoplasm-related pleural effusion. 5 For medical thoracoscopy, evidence shows sensitivity ranging from 86.2 to 93.5% 12 , 14 , 16 ( Table 5 ).…”

History of syncope predicts loss of consciousness after head trauma: Retrospective study

“…However, among various medical procedures, the rate of syncopal events depends on the type of procedure being about 0.01% for vaccination, and 1% for colonoscopy or transthoracic pleural biopsy, up to 5.1% during diagnostic injection [21][22][23][24]. It may be presumed that head trauma evokes a high level of emotion, especially if associated with skin injury, pain, bleeding etc.…”

ERS/ESTS/EACTS/ESTRO guidelines for the management of malignant pleural mesothelioma

“…Pooled results from 1369 patients in 22 case series showed an overall diagnostic sensitivity of 92% [180]. Medical thoracoscopy has been shown to be more successful at diagnosing malignancy than blind or image-guided Abrams biopsies [181][182][183] and had a higher diagnostic yield than CT-guided cutting-needle biopsies in one small randomized trial [184]. The complication rates are very low, with analysis of 47 studies including 4756 patients reporting a mortality rate of 0.34%, major complications in 1.8% and minor complications in 7.8% of cases [180].…”