IMPROVING PLEURAL BIOPSY YIELD THROUGH THE INTEGRATION OF ELECTROCAUTERY INTO SEMI-RIGID MEDICAL THORACOSCOPY

Background: Pleural effusion is the one of the most common clinical conditions encountered in pulmonology clinics and the routinely performed tests on pleural fluid do not provide definitive diagnosis in majority of the cases. Medical thoracoscopy with pleural biopsy under direct vision of the abnormal area provides the highest diagnostic yield. Abrams closed needle pleural biopsy is a conventional and cheaper procedure which can help in the definitive diagosis in cases of undiagnosed pleural effusion. Objectives: To determine the diagnostic yield of abrams pleural biopsy in patients presenting with lymphocytic exudative pleural effusion. Study Design: Cross Sectional Study. Setting: Department of Pulmonology Nishtar Hospital Multan; Tertiary care hospital of 1180 beds. Period: Six months. Results: There were 145 patients diagnosed with lymphocytic exudative pleural effusion. Of these 145 study cases, males were 83/145 (57.2%) whereas females were 62/145 (42.8%). Mean age of our patients was 41.62 ± 13.63 years while mean duration of illness was 7.0 ± 3.24 weeks. When the frequencies of various diagnosis established on the basis of histopathology results obtained from the tissue specimen obtained with Abrams pleural biopsy was noted, Tuberculosis was the major cause of lymphocytic exudative pleural effusion as its frequency was noted to be in 81/145 (55.9%) of our patients while malignancy was present in 26/145 (17.9%) of our study cases whereas the histopathology turned out to be inconclusive in 38/145 (26.2%) showing non-specific inflammation. The diagnostic yield of Abrams pleural biopsy turned out to be 73.8% whereas it was unable to establish diagnosis in 26.2%. Conclusion: Abrams needle pleural biopsy is simple, reliable and safe method of diagnosis with a good diagnostic yield. Routine use of this procedure in patients with lymphocytic exudative pleural effusion can lead to a definitive diagnosis in majority of patients.

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Visceral pleural biopsy under medical thoracoscopy for the diagnosis of lung adenocarcinoma

Respirology Case Reports ◽

10.1002/rcr2.616 ◽

2020 ◽

Vol 8 (6) ◽

Author(s):

Satoshi Terashita ◽

Keiichiro Suminaga ◽

Hiroaki Kawachi ◽

Susumu Noguchi ◽

Tatsuyoshi Ikeue ◽

...

Keyword(s):

Lung Adenocarcinoma ◽

Pleural Biopsy ◽

Medical Thoracoscopy

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Medical Thoracoscopy vs Closed Pleural Biopsy in Pleural Effusions: A Randomized Controlled Study

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2014/7476.4310 ◽

2014 ◽

Author(s):

Nithya Haridas

Keyword(s):

Randomized Controlled Study ◽

Controlled Study ◽

Pleural Effusions ◽

Pleural Biopsy ◽

Randomized Controlled ◽

Medical Thoracoscopy

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Medical Thoracoscopy Versus Closed Pleural Biopsy

Journal of Bronchology & Interventional Pulmonology ◽

10.1097/lbr.0000000000000161 ◽

2015 ◽

Vol 22 (2) ◽

pp. 95-96 ◽

Cited By ~ 1

Author(s):

Katarine Egressy ◽

Septimiu Murgu

Keyword(s):

Pleural Biopsy ◽

Medical Thoracoscopy

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Pleural tuberculosis: medical thoracoscopy greatly increases the diagnostic accuracy

ERJ Open Research ◽

10.1183/23120541.00046-2017 ◽

2018 ◽

Vol 4 (1) ◽

pp. 00046-2017 ◽

Cited By ~ 10

Author(s):

Angelo Gianni Casalini ◽

Pier Anselmo Mori ◽

Maria Majori ◽

Miriam Anghinolfi ◽

Enrico Maria Silini ◽

...

Keyword(s):

Diagnostic Yield ◽

Diagnostic Methods ◽

Fibreoptic Bronchoscopy ◽

Consecutive Series ◽

Pleural Biopsy ◽

Lung Lesions ◽

Molecular Tests ◽

Medical Thoracoscopy ◽

Pleural Tuberculosis ◽

Work Up

Our objective was to evaluate the efficacy of a standardised work-up in the diagnosis of pleural tuberculosis (TB) that included fibreoptic bronchoscopy and medical thoracoscopy.A consecutive series of 52 pleural TB patients observed during the period 2001–2015 was evaluated retrospectively. 20 females, mean (range) age 39.7 (18–74) years, and 32 males, mean (range) age 45.75 (21–83) years, were included (28 non-EU citizens (53.8%)). The diagnosis of TB infections was established by identification (using stains, culture or molecular tests) of Mycobacterium tuberculosis in the pleura, sputum and/or bronchial specimens, or by evidence of caseous granulomas on pleural biopsies. Patients with and without lung lesions were considered separately.The diagnostic yield of the microbiological tests on pleural fluid was 17.3% (nine out of 52 patients). Among the 18 patients with lung lesions, bronchial samples (washing, lavage or biopsy) were positive in 50% of cases (nine patients). Cultures of pleural biopsies were positive in 63% of cases (29 out of 46 patients); pleural histology was relevant in all patients. Without pleural biopsy, a diagnosis would have been reached in 15 out of 52 patients (28.6%) and in four of them only following culture at 30–40 days.An integrated diagnostic work-up that includes all the diagnostic methods of interventional pulmonology is required for a diagnosis of pleural TB. In the majority of patients, a diagnosis can be reached only with pleural biopsy.

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Advanced medical interventions in pleural disease

European Respiratory Review ◽

10.1183/16000617.0020-2016 ◽

2016 ◽

Vol 25 (140) ◽

pp. 199-213 ◽

Cited By ~ 25

Author(s):

Rahul Bhatnagar ◽

John P. Corcoran ◽

Fabien Maldonado ◽

David Feller-Kopman ◽

Julius Janssen ◽

...

Keyword(s):

Point Of Care ◽

Pleural Disease ◽

Randomised Trials ◽

Chemical Pleurodesis ◽

Pleural Biopsy ◽

Future Directions ◽

Pleural Diseases ◽

Medical Interventions ◽

Image Guided ◽

Medical Thoracoscopy

The burden of a number of pleural diseases continues to increase internationally. Although many pleural procedures have historically been the domain of interventional radiologists or thoracic surgeons, in recent years, there has been a marked expansion in the techniques available to the pulmonologist. This has been due in part to both technological advancements and a greater recognition that pleural disease is an important subspecialty of respiratory medicine. This article summarises the important literature relating to a number of advanced pleural interventions, including medical thoracoscopy, the insertion and use of indwelling pleural catheters, pleural manometry, point-of-care thoracic ultrasound, and image-guided closed pleural biopsy. We also aim to inform the reader regarding the latest updates to more established procedures such as chemical pleurodesis, thoracentesis and the management of chest drains, drawing on contemporary data from recent randomised trials. Finally, we shall look to explore the challenges faced by those practicing pleural medicine, especially relating to training, as well as possible future directions for the use and expansion of advanced medical interventions in pleural disease.

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