Determining the optimal number of specimens to obtain with needle biopsy of the pleura

Abstract

The aim of this study was to define the number of pleural biopsy samples necessary for optimum diagnostic performance and determine to what extent they are complementary. Eighty-four closed pleural biopsies were performed in our department between June 1996 and January 1998 on 55 males and 29 females with an average age of 64.4 +/- 16.7 years. The study of the pleural fluid included: pH, biochemical testing of pleura/serum (proteins, lactate dehydrogenase, glucose, cholesterol, triglycerides, albumin and adenosine deaminase), haemogram, cytology and microbiological testing (Gram-staining, aerobes, anaerobes and mycobacteriae cultures). The biopsies were performed using a Cope needle, with a total of five biopsies for each patient: four for pathological examination (taken numerically in the order in which they were performed: D1, D2, D3 and D4) and one for microbiological testing. In those cases in which the diagnosis was uncertain or effusion persisted, a thoracoscopy or thoracotomy was performed. There were no significant differences in the diagnostic yield of each individual sample (D1, D2, D3 and D4), but there were differences in the sum of the samples, depending on the number of biopsies performed.This was true for total group and the group with carcinomas, but not for the group with tuberculosis. The increase in diagnostic yield with the number of biopsies was more remarkable in the carcinoma cases, where it increased by 35% when four biopsies were performed (54% with one biopsy versus 89% with four biopsies, P < 0.002). In conclusion, the diagnostic yield increased with the number of biopsy samples in the total group and the group with malignancy but not in the group with tuberculous effusions. The best diagnostic performance for malignant pathology was obtained with four samples. In pleural tuberculosis, the diagnostic yield did not increase with more biopsy samples. One high quality sample should be enough to obtain a diagnosis.

Direct comparison of the diagnostic yield of ultrasound-assisted Abrams and Tru-Cut needle biopsies for pleural tuberculosis

“…Although this study was not designed to specifically address this issue, this figure is significantly higher than reported figures 33. Malignant disease tends to give rise to focal involvement,25 and the lower thoracic and diaphragmatic parietal pleura are more likely to contain secondary seeding from visceral pleural metastases 34 35. We aimed to use relatively low (supradiaphragmatic) biopsy sites, which may partially explain the relatively high yield observed in our study.…”

“…The use of US prior to closed pleural biopsies is currently advocated,19 29 30 both as a safety measure and to detect localised pleural thickening and other abnormalities 29 30. Pleural TB is a diffuse disease process,25 and it can therefore be postulated that the addition of US prior to the Abrams needle biopsies is unlikely to affect the sensitivity. Although we did not specifically employ US to detect localised abnormalities, our findings certainly support this.…”

CT-guided biopsy versus conventional Abram’s needle biopsy in malignant pleural effusion

“…The reverse-beveled pleural biopsy needle (Abrams needle) was advanced into the pleural space as confirmed by free flow of fluid while aspirating and pulled back to ''hook'' the pleura to collect a biopsy sample. Four to six passes were usually required to obtain an adequate diagnostic specimen as described previously [8,11]. The tissue specimens were examined by an experienced pulmonary pathologist.…”

Toracocentese e biópsia pleural

“…Estudos indicam que, para um desempenho diagnóstico adequado no exame histológico, são necessários pelo menos dois fragmentos de pleura parietal. (24)(25) …”