The diagnostic dilemma of an exudative pleural effusion and the emerging role of thoracoscopic pleural biopsy in these patients: A study from South India

Abstract

Objectives: Pleural effusion is one of the common presentations of several several diseases in clinical practice. The pathology behind a pleural effusion is often not clear on pleural fluid analysis. In developing countries like India, empirical antitubercular treatment is started assuming exudative pleural effusion to be tuberculosis. Over some time with more emphasis on evidence-based medicine, this is not a right approach. Thoracoscopic examination and biopsy visceral are a minimally invasive procedure which is underutilized in our practice. The study was conducted to evaluate the definitive etiological diagnosis of exudative pleural effusion and to analyze the diagnostic yield of thoracoscopic biopsy in the diagnosis of exudative pleural effusion. Material and Methods: The study was conducted in the Department of Medicine and Oncology, Command Hospital Airforce, Bengaluru, India. All adult patients with exudative pleural effusion (according to light’s criteria) reporting to the hospital from January 2019 to December 2020 were included and subjected for analysis. Results: Out of a total of 100 patients who were included in the study, there was male predominance with 78 males and 22 females. Thoracoscopic biopsy remained conclusive in 100% of cases. Malignancy was the most common etiology with 48% of cases while tuberculosis was seen in 38%, 12% had inflammation, and 2 (02%) had mucormycosis. TB PCR sensitivity and specificity of TB PCR were 42% and 100%, respectively. MTB culture showed sensitivity of 11%. MTB culture of biopsy showed sensitivity of 26%. The specificity in both the methods was 100%. Conclusion: Thoracoscopy is an ideal method for the diagnosis of pleural effusion with suspected exudative pathology. It gives an accurate diagnosis and helps differentiate between tuberculosis and malignancy which are the most common etiologies in India, thereby leading to early appropriate and specific treatment in such patients. Malignancy was the most common etiology in our study.