Ultrasound guided pleural biopsy in undiagnosed exudative pleural effusion patients

Introduction: Pleural biopsy for pathological confirmation is the standard diagnostic procedure for pleural diseases, transthoracic ultrasonography (TUS) has evolved as an important imaging tool for diagnosing pleural and pulmonary conditions. Aim of the study: To assess the diagnostic yield of TUS guided pleural biopsy versus both CT guided and thoracoscopic pleural biopsy in the diagnosis of undiagnosed exudative pleural effusion. Patients and methods: The study was conducted at chest department, Zagazig University Hospitals. The study included 60 patients with undiagnosed exudative pleural effusion. They were assigned randomly (by systematic randomization) after signing an informed consent into three groups according to the method by which pleural biopsy was obtained (Group A, TUS guided biopsy group, Group B, CT guided pleural biopsy, Group C, MT pleural biopsy) each included 20 patients. Results: The mean age of the studied patients was 52 ± 10.3 years; they were 27 females and 33 males with no statistical significance. There was no statistical significance between the 3 studied groups regarding, co-morbidities, side of effusion, smoking pattern, and pleural fluid parameters except pleural fluid WBCs (was higher in group B). Malignancy was the most common etiology in 48/60 patients (80%). The diagnostic yield of TUS guided pleural biopsy was 80% versus 85% for CT guided pleural biopsy and 92.5% for thoracoscopic pleural biopsy. Reported complications were (for TUS guided pleural biopsy were; pain in 90% of patients, pneumothorax 5%, hemoptysis 35%, biopsy site bleeding 20% and shock in 15%), (for CT guided biopsy; pain in 100% of patients, pneumothorax 15%, hemoptysis 50%, biopsy site bleeding 60% and shock in 10%), and (for medical thoracoscopy; intra-operative bleeding 3.7%, broncho-pleural fistula 7.4%, failure of lung expansion 14.8%, surgical emphysema 18.5%, post-operative empyema 3.7%). MT was superior in the detection of pleural septations and visceral pleural nodules; the incidence of complication was correlated to the length of the procedure time in MT group. In conclusion: Thoracic ultrasound (TUS) guided pleural biopsy had a diagnostic yield which was slightly lower but comparable to both CT guided pleural biopsy and medical thoracoscopic pleural biopsy (MT)