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 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.

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Pleural tuberculosis

Monaldi Archives for Chest Disease ◽

10.4081/monaldi.2006.582 ◽

2016 ◽

Vol 65 (1) ◽

Cited By ~ 2

Author(s):

B. Chakrabarti ◽

P.D.O. Davies

Keyword(s):

Pleural Fluid ◽

Diagnostic Yield ◽

Western World ◽

Pleural Effusions ◽

Pleural Biopsy ◽

Biopsy Specimens ◽

Tuberculous Pleurisy ◽

The Impact ◽

Antituberculous Chemotherapy

Pleural effusions in tuberculosis are commonly seen in young adults as an immunological phenomenon occurring soon after primary infection. However, the epidemiology and demographics of tuberculous pleurisy are changing due to the impact of HIV co-infection and the increasing number of pleural effusions seen as part of re-activation disease. Pleural biopsy for histology and culture is the mainstay of diagnosis with closed needle biopsy adequate in the majority of cases. Techniques such as PCR of biopsy specimens and the role of pleural fluid ADA are still being evaluated as a diagnostic aid. Tuberculous empyema is less commonly seen in the western world and the diagnostic yield from pleural fluid here is greater than in “primary” effusions. Treatment with appropriate antituberculous chemotherapy is generally successful though there is currently insufficient evidence to recommend the routine use of corticosteroids in this condition.

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Image-guided pleural biopsy: diagnostic yield and complications

Clinical Radiology ◽

10.1016/j.crad.2006.05.002 ◽

2006 ◽

Vol 61 (8) ◽

pp. 700-705 ◽

Cited By ~ 40

Author(s):

R.E. Benamore ◽

K. Scott ◽

C.J. Richards ◽

J.J. Entwisle

Keyword(s):

Diagnostic Yield ◽

Pleural Biopsy ◽

Image Guided

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Interventional Radiology

10.1093/med/9780190276249.001.0001 ◽

2018 ◽

Keyword(s):

Interventional Radiology ◽

Clinical Practice ◽

Broad Spectrum ◽

Patient Management ◽

Procedural Knowledge ◽

Holistic Approach ◽

Medical Specialties ◽

Image Guided ◽

Comprehensive Text

In 2012, the American Board of Medical Specialties (ABMS) approved Interventional Radiology (IR) as its own specialty. Born out of the field of Diagnostic Radiology, IR requires a more clinical focus on initial consultation and post-procedural management, rather than its previous role of performing image-guided procedures. Interventional Radiology: Fundamentals of Clinical Practice is written with this new focus in mind to help readers incorporate their procedural knowledge into a holistic approach of patient management. Chapters explore topics across a broad spectrum of IR, with a focus on etiology and pathophysiology of disease, followed by discussions on intra-procedural and post-procedural management. Numerous tables and boxes, and over 420 total figures complement chapter content. This comprehensive text is a must-have text for IR residents and reference for all practicing interventional radiologists.

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Diagnostic yield and safety of image-guided pleural biopsy: a systematic review and meta-analysis

10.1183/13993003.congress-2020.2789 ◽

2020 ◽

Author(s):

Federico Mei ◽

Martina Bonifazi ◽

Matteo Rota ◽

Lina Zuccatosta ◽

Eihab O Bedawi ◽

...

Keyword(s):

Systematic Review ◽

Diagnostic Yield ◽

Meta Analysis ◽

Pleural Biopsy ◽

Image Guided

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The Usefulness of Clinical-Practice-Based Laboratory Data in Facilitating the Diagnosis of Dengue Illness

BioMed Research International ◽

10.1155/2013/198797 ◽

2013 ◽

Vol 2013 ◽

pp. 1-11 ◽

Cited By ~ 10

Author(s):

Jien-Wei Liu ◽

Ing-Kit Lee ◽

Lin Wang ◽

Rong-Fu Chen ◽

Kuender D. Yang

Keyword(s):

Clinical Practice ◽

Predictive Value ◽

Viral Infections ◽

Laboratory Data ◽

Hemorrhagic Fever ◽

Complementary Role ◽

Prolonged Aptt ◽

Laboratory Variables ◽

Sensitivity Specificity

Alertness to dengue and making a timely diagnosis is extremely important in the treatment of dengue and containment of dengue epidemics. We evaluated the complementary role of clinical-practice-based laboratory data in facilitating suspicion/diagnosis of dengue. One hundred overall dengue (57 dengue fever [DF] and 43 dengue hemorrhagic fever [DHF]) cases and another 100 nondengue cases (78 viral infections other than dengue, 6 bacterial sepsis, and 16 miscellaneous diseases) were analyzed. We separately compared individual laboratory variables (platelet count [PC] , prothrombin time [PT], activated partial thromboplastin time [APTT], alanine aminotransferase [ALT], and aspartate aminotransferase [AST]) and varied combined variables of DF and/or DHF cases with the corresponding ones of nondengue cases. The sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) in the diagnosis of DF and/or DHF were measured based on these laboratory variables. While trade-off between sensitivity and specificity, and/or suboptimal PPV/NPV was found at measurements using these variables, prolonged APTT + normal PT + PC < 100 × 109cells/L had a favorable sensitivity, specificity, PPV, and NPV in diagnosis of DF and/or DHF. In conclusion, these data suggested that prolonged APTT + normal PT + PC < 100 × 109cells/L is useful in evaluating the likelihood of DF and/or DHF.

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Diagnostic Yield and Safety of Endoscopic Ultrasound Guided Fine Needle Aspiration of Central Mediastinal Lung Masses

Diagnostic and Therapeutic Endoscopy ◽

10.1155/2013/150492 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6 ◽

Cited By ~ 10

Author(s):

Enrique Vazquez-Sequeiros ◽

Michael J. Levy ◽

Manuel Van Domselaar ◽

Fernando González-Panizo ◽

Jose Ramon Foruny-Olcina ◽

...

Keyword(s):

Diagnostic Yield ◽

Outcome Measurement ◽

Primary Lung Cancer ◽

Needle Aspiration ◽

Lung Mass ◽

Tertiary Referral Center ◽

Safe Technique ◽

Few Data ◽

Sensitivity Specificity

Background and Aims. EUS-FNA is an accurate and safe technique to biopsy mediastinal lymph nodes. However, there are few data pertaining to the role of EUS-FNA to biopsy central lung masses. The aim of the study was to assess the diagnostic yield and safety of EUS-FNA of indeterminate central mediastinal lung masses. Methods. Design: Retrospective review of a prospectively maintained database; noncomparative. Setting: Tertiary referral center. From 10/2004 to 12/2010, all patients with a lung mass located within proximity to the esophagus were referred for EUS-FNA. Main Outcome Measurement: EUS-FNA diagnostic accuracy and safety. Results. 73 consecutive patients were included. EUS allowed detection in 62 (85%) patients with lack of visualization prohibiting FNA in 11 patients. Among sampled lesions, one patient (1/62 = 1.6%) had a benign lung mass (hamartoma), while the remaining 61 patients (61/62 = 98.4%) had a malignant mass (primary lung cancer: 55/61 = 90%; lung metastasis: 6/61 = 10%). The sensitivity, specificity, and accuracy of EUS-FNA were 96.7%, 100%, and 96.7%, respectively. The sensitivity was 80.8% when considering nonvisualized masses. One patient developed a pneumothorax (1/62 = 1.6%). Conclusions. EUS-FNA appears to be an accurate and safe technique for tissue diagnosis of central mediastinal lung masses.

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The miR-21 potential of serving as a biomarker for liver diseases in clinical practice

Biochemical Society Transactions ◽

10.1042/bst20200653 ◽

2020 ◽

Vol 48 (5) ◽

pp. 2295-2305

Author(s):

Jiawei Zhang ◽

Dandan Li ◽

Rui Zhang ◽

Peng Gao ◽

Rongxue Peng ◽

...

Keyword(s):

Clinical Practice ◽

Liver Diseases ◽

Hepatic Disease ◽

Noninvasive Detection ◽

Diagnosis And Prognosis ◽

Expected Performance ◽

Potential Biomarker ◽

Disease Condition ◽

Complex Regulatory Network

The role of miR-21 in the pathogenesis of various liver diseases, together with the possibility of detecting microRNA in the circulation, makes miR-21 a potential biomarker for noninvasive detection. In this review, we summarize the potential utility of extracellular miR-21 in the clinical management of hepatic disease patients and compared it with the current clinical practice. MiR-21 shows screening and prognostic value for liver cancer. In liver cirrhosis, miR-21 may serve as a biomarker for the differentiating diagnosis and prognosis. MiR-21 is also a potential biomarker for the severity of hepatitis. We elucidate the disease condition under which miR-21 testing can reach the expected performance. Though miR-21 is a key regulator of liver diseases, microRNAs coordinate with each other in the complex regulatory network. As a result, the performance of miR-21 is better when combined with other microRNAs or classical biomarkers under certain clinical circumstances.

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