Role of Blind Closed Pleural Biopsy in the Management of Pleural Exudates

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 wh...

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Bibliographic Details
Published in:Canadian respiratory journal 2013, Vol.20 (5), p.362-366
Main Authors: 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
Format: Article
Language:English
Subjects:
Biopsy
Cellular biology
Lung diseases
Medical procedures
Original
Studies
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Summary: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.
ISSN:1198-2241
1916-7245
DOI:10.1155/2013/731352