Value of thoracoscopic pleural brush in the diagnosis of exudative pleural effusion

Background: Nowadays, medical thoracoscope had been established to have greater diagnostic yield in the diagnosis of exudative pleural effusion. Forceps biopsy and pleural brush could be used through medical thoracoscope to obtain pleural cytopathological specimens, however the most popular used one was the forceps biopsy. Aim of this study: To evaluate the value of thoracoscopic pleural brush in the diagnosis of exudative pleural effusion. Study design: Interventional prospective study. Setting: Endoscopy Unit, Chest Department, Assiut University Hospital, Egypt. Material and methods: The study was conducted upon 28 patients with exudative pleural effusion from January 2011 to December 2011, in whom both the conventional pleural tapping and closed pleural biopsy were not conclusive. All patients submitted for medical thoracoscope, where forceps biopsy and pleural brush specimens were taken for all patients. Results: Thoracoscopic pleural specimens were diagnostic in 26 patients out of 28 ones (92.9%). Histopathological examination of thoracoscopic specimens revealed malignant lesions in (20 patients), TB in (two patients) and non specific inflammation in (four patients). Forceps biopsy was positive in 22 patients, while pleural brush was positive in 17 patients. Thoracoscopic pleural brush was the only diagnostic modality in four patients all were adenocarcinoma. The lesions were mostly on the visceral pleura in one patient in whom visceral pleural brush was taken, while bleeding occurred with forceps biopsy in the other three patient. No complications recorded with pleural brush procedures. Conclusion: Thoracoscopic pleural brushing could be done easily and safely and allows obtaining pleural cellular material in areas dangerous to take biopsy specimens. It could augment the diagnostic yield of medical thoracoscope