Canadian respiratory journal · 2013
Role of blind closed pleural biopsy in the managment of pleural exudates.
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Pereyra Marco F, San-José Esther, Ferreiro Lucía, Golpe Antonio, Antúnez José, González-Barcala Francisco-Javier, Abdulkader Ihab, Álvarez-Dobaño José M, Rodríguez-Núñez Nuria, Valdés Luis
Аннотация
INTRODUCTION: The performance of blind closed pleural biopsy (BCPB) in the study of pleural exudates is controversial.
OBJECTIVE: To assess the diagnostic yield of BCPB in clinical practice and its role in the study of pleural exudates.
METHODS: Data were retrospectively collected on all patients who underwent BCPB performed between January 1999 and December 2011.
RESULTS: A total of 658 BCPBs were performed on 575 patients. Pleural tissue was obtained in 590 (89.7%) of the biopsies. A malignant pleural effusion was found in 35% of patients. The cytology and the BCPB were positive in 69.2% and 59.2% of the patients, respectively. Of the patients with negative cytology, 21 had a positive BCPB (diagnostic improvement, 15%), which would have avoided one pleuroscopy for every seven BCPBs that were performed. Of the 113 patients with a tuberculous effusion, granulomas were observed in 87 and the Lowenstein culture was positive in an additional 17 (sensitivity 92%). The overall sensitivity was 33.9%, with a specificity and positive predictive value of 100%, and a negative predictive value of 71%. Complications were recorded in 14.4% of patients (pneumothorax 9.4%; chest pain 5.6%; vasovagal reaction, 4.1%; biopsy of another organ 0.5%).
CONCLUSIONS: BCPB still has a significant role in the study of a pleural exudate. If an image-guided technique is unavailable, it seems reasonable to perform BCPB before resorting to a pleuroscopy. These results support BCPB as a relatively safe technique.
OBJECTIVE: To assess the diagnostic yield of BCPB in clinical practice and its role in the study of pleural exudates.
METHODS: Data were retrospectively collected on all patients who underwent BCPB performed between January 1999 and December 2011.
RESULTS: A total of 658 BCPBs were performed on 575 patients. Pleural tissue was obtained in 590 (89.7%) of the biopsies. A malignant pleural effusion was found in 35% of patients. The cytology and the BCPB were positive in 69.2% and 59.2% of the patients, respectively. Of the patients with negative cytology, 21 had a positive BCPB (diagnostic improvement, 15%), which would have avoided one pleuroscopy for every seven BCPBs that were performed. Of the 113 patients with a tuberculous effusion, granulomas were observed in 87 and the Lowenstein culture was positive in an additional 17 (sensitivity 92%). The overall sensitivity was 33.9%, with a specificity and positive predictive value of 100%, and a negative predictive value of 71%. Complications were recorded in 14.4% of patients (pneumothorax 9.4%; chest pain 5.6%; vasovagal reaction, 4.1%; biopsy of another organ 0.5%).
CONCLUSIONS: BCPB still has a significant role in the study of a pleural exudate. If an image-guided technique is unavailable, it seems reasonable to perform BCPB before resorting to a pleuroscopy. These results support BCPB as a relatively safe technique.