Comparative efficacy and complications of Transthoracic Ultrasound guided Pleural biopsy versus Medical thoracoscopic Pleural biopsy in Undiagnosed Exudative Pleural Effusion: Experience from a Tertiary Care Institute of Eastern India.

BACKGROUND

Approximately 20% of exudative pleural effusions remain undiagnosed even after diagnostic thoracentesis. In such situations, pleural biopsy is essential for establishing a diagnosis. Pleural biopsy can be obtained either through invasive procedures, such as medical or surgical thoracoscopy, or through semi-invasive techniques, such as closed pleural biopsy, with or without image guidance. This study compared the efficacy and complications of transthoracic ultrasound-guided versus medical thoracoscopic pleural biopsy for undiagnosed exudative pleural effusion.

METHODOLOGY: This prospective observational comparative study included 110 patients who were randomly assigned to undergo either ultrasound-guided pleural biopsy (UPB) or medical thoracoscopic pleural biopsy (TPB) under local anesthesia. The specimens were sent for histopathological examination (HPE) and GeneXpert for Mycobacterium tuberculosis (CBNAAT).

RESULTS

Conclusive diagnosis was achieved in 96% of TPB cases and 95% of UPB cases. Malignancy predominated in TPB (56%), whereas tuberculosis in UPB (47%). Among the tuberculosis cases, CBNAAT was positive in 18 UPB and 12 TPB cases, with two rifampicin-resistant cases in each group. The mean hospital stay was longer in TPB (11.3 days) than in UPB (1.5 days), and complications were fewer in UPB.

CONCLUSION

Both UPB and TPB can be used in undiagnosed pleural effusion cases. Although TPB is the gold standard for diagnosing pleural diseases, UPB is a less invasive, relatively safer, and simpler procedure.