Role of pleural biopsy in etiological diagnosis of pleural effusion

Abstract

Background:Pleural effusion remains the most common manifestation of pleural pathology. Sometimes it is difficult to differentiate between tubercular and malignant pleural effusion in spite of routine biochemical and cytological examination of pleural fluid.Aims:This study aims to evaluate the role of pleural biopsy to determine the etiology of pleural effusion and to correlate it with the biochemical and cytological parameters of pleural fluid.Settings and Design:Seventy two consecutive patients of pleural effusion were selected from the out patient and indoor department of a tertiary hospital of Kolkata. It was a prospective and observational study conducted over a period of one year.Materials and Methods:Biochemical, cytological and microbiological evaluation of pleural fluid was done in all cases. Those with exudative pleural effusions underwent pleural biopsy by Abram’s needle. Subsequently, the etiology of effusion was determined.Results:Malignancy was the most common etiology, followed by tuberculosis. Pleural biopsy was done in 72 patients. Pleural tissue was obtained in 62 cases. Malignancy was diagnosed in 24, tuberculosis in 20 and non-specific inflammation in 18, on histopathological examination. Out of 20 histological proven tuberculosis cases adenosine de-aminase (ADA) was more than 70 u/l in 11 cases.Conclusions:In our study, malignancy is more common than tuberculosis, particularly in elderly. When thoracoscope is not available, pleural fluid cytology and pleural biopsy can give definite diagnosis. Pleural fluid ADA ≥ 70 u/l is almost diagnostic of tuberculosis, where pleural biopsy is not recommended.

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.…”

Role of Pleural Biopsy in the Etiological Diagnosis of Exudative Pleural Effusion

“…This is similar to other studies. 6,15,16 Among the pleural malignancy, metastatic adenocarcinoma was the most frequent type (70%) of malignancy found. This is similar to some other study.…”

“…This finding is similar to other study. 15 So in a undiagnosed case of exudative pleural effusion where pleural biopsy is not possible, highly elevated pleural fluid ADA and LDH may point to a diagnosis of pleural TB.…”

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

“…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.…”