Study of comparison of medical thoracoscopic guided biopsy versus closed pleural biopsy for etiological diagnosis of undiagnosed exudative pleural effusions: A randomized controlled study.

BACKGROUND

Medical thoracoscopy (MT) has gained widespread acceptance in the diagnosis of undiagnosed exudative pleural effusions. In developing countries, including India medical thoracoscopy is not widely available.

AIMS: 1. To analyze the yield of closed pleural biopsy (CPB) in comparison with MT in the diagnosis of undiagnosed exudative pleural effusions. 2. Comparison of complications between CPB and MT.

METHODOLOGY: This was a prospective randomized controlled study conducted in a tertiary care centre, from January 2020 to September 2021. The patients with undiagnosed exudative pleural effusions were included in the study. The enrolled patients were randomized into two groups, group A and group B. Total of 38 patients were taken, 19 patients in each group. Group A was subjected to MT. Group B was subjected to CPB with cope's needle. Ultrasound was used to mark the site of pleural effusion.

RESULTS

Diagnostic yield was 78.9% in both MT and CPB group. CPB was significantly less painful procedure compared to MT. The duration of hospital stay was also significantly less in CPB as compared to MT (P < 0.001). CPB was associated with 5.3% mortality and there was no mortality in MT group.

CONCLUSIONS

Our study recommends that, in the era of medical thoracoscopy, closed pleural biopsy still holds a significant role in the diagnosis of undiagnosed exudative pleural effusions especially where prevalence of tuberculosis is high. It is also a cost effective approach in developing countries like India.