Role of percutaneous closed needle pleural biopsy among patients of undiagnosed exudative pleural effusion

Abstract

Background:Sometimes etiological diagnosis of pleural effusion is difficult despite cytological, biochemical and microbiological tests and labeled as undiagnosed exudative pleural effusions.Aim of present study was to make an etiological diagnosis of pleural effusion.Materials and Methods:Study group included patients of exudative pleural effusion where etiological diagnosis could not be yielded by conventional cytological, biochemical and microbiological investigations. Pleural tissue was obtained by Cope’s pleural biopsy needle and or thoracoscopy. Pleural biopsy was subjected to histopathology, ZN staining and culture to find the mycobacterium tuberculosis.Results:Out of 25 patients, 17 (68%) and 8 (32%) were male and female, respectively. Age ranged from 15 to 65 years (mean 31.72). Mean value of serum and pleural fluid LDH was 170.56 U/L and 1080.28 U/L, respectively. Histopathology of 9 (36%) showed epitheloid granuloma with caseation necrosis. In other 9 (36%) patients, epitheloid granulomas (with or without giant cells) was reported. In 5 (20%) patients, histopathology report was of nonspecific chronic inflammation. Histopathology was reported as normal in one case; it turned out to be a case of malignancy. In two (8%) patients, pleural tissue obtained was inadequate for opinions; however, other tests revealed malignancy in one and tuberculosis in other. Ziehl-Neelsen (ZN) stain was positive for AFB in two patients and culture of pleural tissue showed presence of Mycobacterium tuberculosis in three patients.Conclusions:The role of percutaneous closed needle biopsy of pleura among patients of undiagnosed exudative pleural effusion is still accepted as a diagnostic tool, as this may lead to a specific diagnosis among 76% of cases. This is of particular importance in a developing country like India where the facilities of thoracoscopy and imaging guided cutting needle biopsies are not easily available.

Role of Medical Thoracoscopy and Closed-Blind Pleural Biopsy in Undiagnosed Exudative Pleural Effusions

“…25 Blind pleural biopsy was nonrepresentative in 15.5% patients who underwent CBPB, and similar rates of nonrepresentative samples with blind pleural biopsies have been reported in other studies also. 3,15 Pleural biopsies could not be obtained in 6.8% of the patients undergoing MT in this study, and is marginally higher than the earlier reported rates. 13,14 This is probably due to the delayed presentation of patients to our center, which led to the formation of multiple pleural adhesions.…”

“…Hence, in many centers, CBPB continues to be performed in the workup of undiagnosed EPE. 6,[15][16][17] In this retrospective study, we describe our experience with MT and also compare the outcome of thoracoscopy (both rigid and semirigid) with that of CBPB.…”

Pleural effusion: Role of pleural fluid cytology, adenosine deaminase level, and pleural biopsy in diagnosis

“…In the present study as well in 94.4% of malignant pleural effusions, ADA levels were below 40 IU/L. [25121314] However, two patients (5.6%) had ADA levels 46.2 IU/L and 46.7 IU/L respectively who were diagnosed to have malignancy on pleural biopsy subsequently.…”

Clinico- pathological profile and course of malignant pleural effusion in a tertiary care teaching hospital in western U.P. with special reference to lung cancer

“…Percutaneous closed pleural biopsy was done in 108 and was positive in 53 (49%) cases. A closed needle biopsy of the pleura has been found to be very useful in cases of undiagnosed exudative pleural effusion,[ 16 ] as it reaches a specific diagnosis in a majority of the cases, causes little morbidity or mortality, and can be performed with little instrumental and manpower support. This is of importance in a developing country like India where the facilities of thoracoscopy and imaging-guided cutting needle biopsies are not easily available.…”