Ultrasound-Guided versus Thoracoscopic Pleural Biopsy for Diagnosing Tuberculous Pleurisy Following Inconclusive Thoracentesis: A Randomized, Controlled Trial

Abstract

BackgroundTraditional diagnostic methods for tuberculosis (TB) cannot be reliably applied to tuberculous pleurisy. Therefore, this prospective, randomized, controlled trial was performed to compare the diagnostic sensitivity and safety of ultrasound-guided cutting-needle pleural biopsy versus thoracoscopic pleural biopsy in patients suspected of tuberculous pleurisy following inconclusive thoracentesis.Material/MethodsA total of 196 adult patients with acid-fast bacillus (AFB)-negative exudative pleural effusions clinically suspected of tuberculous pleurisy were recruited. Enrollees were randomized into 2 cohorts: ultrasound-guided cutting-needle pleural biopsy (n=96) or thoracoscopic pleural biopsy (n=96). The overall diagnostic yields, diagnostic sensitivities for tuberculous pleurisy, and post-procedural complications for both cohorts were statistically compared.ResultsUltrasound-guided pleural biopsy displayed an overall diagnostic yield of 83%, while thorascopic pleural biopsy displayed a similar overall diagnostic yield of 86% (χ2=1.88, df=1, p=0.17). There were 127 patients conclusively diagnosed with tuberculous pleurisy, resulting in a tuberculous pleurisy prevalence of 65% in this patient population (66% in the ultrasound cohort vs. 63% in the thoracoscopy cohort; p>0.05). Ultrasound-guided pleural biopsy displayed a sensitivity of 82% in detecting tuberculous pleurisy, while thorascopic pleural biopsy displayed a similar sensitivity of 90% (χ2=1.05, df=1, p=0.30). The sensitivities of these 2 modalities did not significantly differ based on the degree of pleural thickening (p>0.05). Post-procedural complications were minor.ConclusionsUltrasound-guided and thoracoscopic pleural biopsy both display strong (>80%) but statistically similar overall diagnostic yields for diagnosing pleural effusions following inconclusive thoracentesis. Both modalities also display strong (>80%) but statistically similar sensitivities in detecting tuberculous pleurisy.

Ultrasound-Guided Percutaneous Core Needle Biopsy of Peripheral Pulmonary Nodules ≤ 2 cm: Diagnostic Performance, Safety and Influence Factors

“…In this situation, a large needle will take advantage over a smaller one in acquiring adequate tissue sample. Many studies have demonstrated that US-guided percutaneous biopsy for PPLs is effective and the accuracy has ranged from 82%~96% in confirmative pathological diagnoses (7,(19)(20)(21)(22)(23)(24). In terms of diagnostic accuracy, the overall rate was 81.4% in this study, which was comparable to those of previous studies.…”

Diagnostic Value of Ultrasound-Guided Pleural Biopsy in Patients with Recurrent Pleural Effusion

“…When comparing the performance of ultrasoundguided biopsy to thoracoscopy, Sobhy et al (19) found thoracoscopy to have a higher sensitivity (94% vs 77.7%) in diagnosing pleural diseases. On the contrary Zhou et al (20) found both modalities to have statistically similar diagnostic yields in cases of pleural effusion after inconclusive thoracocentesis. With such findings ultrasound-guided biopsy being a simple cheap procedure would be favored to thoracoscopy, a more expensive & invasive procedure that is not necessarily available in small peripheral units in the country.…”

Pediatric Chest Ultrasound for Bedside Diagnosis of Pneumonia: A Validation Study for Diagnostic Options in Developing Countries

“…It might point to an underlying etiology other than CAP e.g. immune disease that involves the lung (26), or tuberculosis (27), etc. albeit being rare.…”