Pleural tuberculosis: medical thoracoscopy greatly increases the diagnostic accuracy

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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Role of Ultrasound-Guided Tru-cut Biopsy in the Diagnosis of Peripheral Lung and Pleural Lesions

QJM ◽

10.1093/qjmed/hcab087.003 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Khaled Mohamed Wagih ◽

Nehad Mohammed Osman ◽

walid Heta ◽

Fatma El-Zahraa Abdellatif

Keyword(s):

Diagnostic Yield ◽

Tube Placement ◽

Consecutive Series ◽

University Hospitals ◽

Transthoracic Needle Biopsy ◽

Lung Lesions ◽

Pulmonary Lesions ◽

Guided Biopsy ◽

High Flow Oxygen ◽

Peripheral Lung

Abstract Background Transthoracic needle biopsy is a well-established technique for diagnosing pulmonary lesions. Computed tomography (CT) is usually used as guidance. Ultrasound (US)-guided biopsy is a relatively affordable modality for diagnosis of peripheral lung lesions (PLLs; also known as peripheral pulmonary lesions [PPLs]) and peripheral pleural lesions. Objectives The purpose of this study was to study the diagnostic yield of US guidance sampling a consecutive series of peripheral lung and pleural lesions and potential factors influencing the diagnostic yield with recording the occurrence of any complications. Patients and Methods This was a prospective study that was conducted at Ain Shams University Hospitals upon a population of 60 patients, during the period from September 2018 to August 2019. A special puncture transducer is used to perform US-guided biopsy with visualization of the biopsy needle and the lesion; facilitating the sampling procedure. Results The use of US-guided transthoracic needle biopsies across 60 patients was shown to have a yield of 75% which found the occurrence of 45 conclusive and 15 non-conclusive results From this study population, 70% (n = 42/45) were found to have malignant manifestations, of which 26 were undifferentiated high grade adenocarcinoma, and 9 were moderately differentiated adenocarcinoma. As for complications arising from the biopsy procedure, twenty percent 20% (n = 12) of patients suffered from complications in the form of hemoptysis in 8 which was controlled by hemostatic measures and 4 patients acquired pneumothorax, three (¾) of them received high flow oxygen and conservative treatment and only one (1/4) patient had intercostal tube placement. Diagnostic yield was significantly increased with the presence of Wedge shaped hypoechoic lesions(p < 0.001), hard Mass consistency was significantly highly associated with conclusive results (p < 0.001), as well as a significant link between the longitudinal diameter of masses that had a mean length of 45.05mm ±12.93mm (#x0003D; 0.029).It also showed that more biopsies taken were highly significant correlation with conclusive outcomes (p < 0.001). Conclusion US-guided biopsy is a robust and accurate procedure to effectively diagnose peripheral lung lesions, with a low incidence of complications and gradually improving results with the mastery of the procedure.

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DIAGNOSTIC YIELD OF ABRAMS PLEURAL BIOPSY IN PATIENTS PRESENTING WITH LYMPHOCYTIC EXUDATIVE PLEURAL EFFUSION.

The Professional Medical Journal ◽

10.29309/tpmj/2019.26.07.1389 ◽

2019 ◽

Vol 26 (07) ◽

pp. 1014-1019

Author(s):

Kashif Sardar ◽

Nasir Javed ◽

Sufyan Saleem Safdar

Keyword(s):

Pleural Effusion ◽

Diagnostic Yield ◽

Tertiary Care ◽

Cross Sectional Study ◽

Definitive Diagnosis ◽

Care Hospital ◽

Pleural Biopsy ◽

Cross Sectional ◽

Medical Thoracoscopy ◽

Exudative Pleural Effusion

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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Visual Diagnosis of Pleural Tuberculosis and its Association with Tissue Biopsy, Culture and Xpert Assay

Pneumologie ◽

10.1055/a-1666-5851 ◽

2021 ◽

Author(s):

Kamran Khan Sumalani ◽

Nousheen Akhter ◽

Dimple Chawla ◽

Nadeem Ahmed Rizvi

Keyword(s):

Diagnostic Yield ◽

Strong Association ◽

Granulomatous Inflammation ◽

P Value ◽

Inclusion Criteria ◽

Medical Thoracoscopy ◽

Pleural Tuberculosis ◽

High Positive Predictive Value ◽

Tuberculous Pleurisy ◽

Visual Diagnosis

Abstract Introduction The diagnosis of pleural tuberculosis remains a clinical challenge due to the paucibacillary nature of disease. Medical thoracoscopy remains the gold standard in diagnosing tuberculous pleuritis. Objective To establish the diagnostic yield of sago-seed thoracoscopic appearance of pleura in tuberculosis and its correlation with histopathology, tissue AFB culture and tissue Xpert MTB/Rif assay. Methods All consecutive patients with lymphocytic exudative pleural effusion, who fulfilled inclusion criteria of the study underwent medical thoracoscopy under local anesthesia and pleural tissue was sent for histopathology, AFB culture and Xpert MTB/Rif assay. Chronic granulomatous inflammation on histopathology and response to anti-tuberculous treatment was taken as reference standard for diagnosis of tuberculous pleurisy. Results A total of 249 patients were included in the study, out of which 168 had effusion secondary to tuberculosis. Sago-like nodules visualized on thoracoscopy had a sensitivity of 58.9 %, specificity of 92.6 % and diagnostic accuracy of 69.88 % for pleural tuberculosis. There is a strong association between the presence of sago-like nodules and detection of mycobacterium tuberculosis on Xpert MTB/Rif assay and AFB culture of pleura (p-value 0.007). Conclusion Sago seed nodules on pleura have a high positive predictive value for tuberculous pleurisy. In high endemic countries patients with this finding on thoracoscopy can be commenced on anti-tuberculous treatment before histopathology or culture results are available.

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Comparison of diagnostic yield and complications of bronchoscopy, closed pleural biopsy and medical thoracoscopic pleural biopsies in undiagnosed pleural effusions

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20170014 ◽

2017 ◽

Vol 5 (2) ◽

pp. 388

Author(s):

Kizhakkepeedika Davis Rennis ◽

Jaboy Bibin ◽

Vadakkan Thomas ◽

Easwaramangalath Venugopal Krishnakumar

Keyword(s):

Pleural Effusion ◽

Diagnostic Yield ◽

Safe Procedure ◽

Pleural Effusions ◽

Pleural Biopsy ◽

Predictive Values ◽

Medical Thoracoscopy ◽

Sensitivity Specificity ◽

Blunt Trocar ◽

Exudative Pleural Effusion

Background: Undiagnosed exudative pleural effusion is a commonly encountered clinical scenario, which requires further evaluation. This study was aimed to analyze the diagnostic yield and complications of three procedures- Bronchoscopy, closed (Abram’s) pleural biopsy and medical thoracoscopy. Further, this study assessed whether combining closed pleural biopsy with bronchoscopy can be a substitute for medical thoracoscopy.Methods: An observational study was conducted among people with undiagnosed exudative pleural effusion. Initially, closed pleural biopsies were performed with Abrams needle and multiple tissue fragments were taken through the incision and the samples were sent in formalin to the laboratory for histopathology examination. For thoracoscopy, a cannula of 10 mm diameter with blunt trocar was inserted into the pleural cavity and semi rigid thoracoscope was introduced through the trocar. Bronchoscopy was performed 48 hours after thoracoscopy. Sensitivity, specificity and positive and negative predictive values were calculated and compared.Results: Out of 25 people, 14 were diagnosed to have malignancy and 7 were diagnosed tuberculosis. The overall sensitivity of the three procedures were 28.5% for closed pleural biopsy, 14.2% for bronchoscopy, 95.2% for medical thoracoscopy, 42.8% for the combined pleural biopsy and bronchoscopy. The complication rate was lowest for bronchoscopy (4%), followed by medical thoracoscopy (8%) and closed pleural biopsy (16%).Conclusions: Medical thoracoscopy is a comparatively safe procedure which has got the highest sensitivity for the diagnosis of undiagnosed exudative pleural effusions. Bronchoscopy combined with closed pleural biopsy, the diagnostic yield was increased (than that of individual yield), but cannot be a substitute for medical thoracoscopy.

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Diagnostic yield of sputum induction in patients with pleural tuberculosis at a tertiary care hospital in Karachi

The International Journal of Tuberculosis and Lung Disease ◽

10.5588/ijtld.18.0830 ◽

2019 ◽

Vol 23 (11) ◽

pp. 1213-1216 ◽

Cited By ~ 2

Author(s):

K. K. Sumalani ◽

N. Akhter ◽

D. Chawla ◽

N. A. Rizvi

Keyword(s):

Diagnostic Yield ◽

Tertiary Care ◽

Lung Parenchyma ◽

Normal Lung ◽

Care Hospital ◽

Sputum Induction ◽

Pleural Biopsy ◽

Acid Fast Bacilli ◽

Pleural Tuberculosis ◽

Xpert Assay

OBJECTIVE: To evaluate the diagnostic yield of acid-fast bacilli (AFB) smear, culture for Mycobacterium tuberculosis and Xpert® MTB/RIF assay in induced sputum (IS) specimens in patients with pleural tuberculosis (TB).DESIGN: A total of 156 patients were evaluated at Jinnah Postgraduate Medical Centre, Karachi, Pakistan, from April 2016 to December 2017. Patients with exudative lymphocytic pleural effusions with normal lung parenchyma on chest radiography were included in the study: 102 were due to tuberculous and 54 due to non-tuberculous infections as diagnosed using thoracoscopic pleural biopsy. IS samples were sent for acid-fast bacilli (AFB) smear, AFB culture and Xpert assay.RESULT: In patients with a clinical diagnosis of TB, mycobacteria were detected in IS AFB smear in 7.8%, AFB culture in 21.6% and Xpert assay in 34.3% of cases. All sputum samples collected from patients with non-tuberculous aetiology were negative.CONCLUSION: Testing IS samples for M. tuberculosis provides another approach to diagnosing pleural TB, especially in settings in which invasive procedures are less accessible. Our study also emphasises the contagiousness of pleural TB, and the need to screen the household contacts of these patients and possible isolation of patients with pleural TB admitted to hospital.

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Diagnostic yield of Xpert MTB/RIF on Contrast-enhanced Ultrasound Guided Pleural Biopsy Specimens for Pleural Tuberculosis

International Journal of Infectious Diseases ◽

10.1016/j.ijid.2021.05.023 ◽

2021 ◽

Author(s):

Wenwen Sun ◽

Yiming Zhou ◽

Wenting Li ◽

Yin Wang ◽

kunlong Xiong ◽

...

Keyword(s):

Diagnostic Yield ◽

Contrast Enhanced Ultrasound ◽

Ultrasound Guided ◽

Pleural Biopsy ◽

Biopsy Specimens ◽

Pleural Tuberculosis ◽

Contrast Enhanced

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Comparing Diagnostic Yield of Electromagnetic Navigational Bronchoscopy Guided With Real Time Cone Beam Computer Tomography Compared to Standard Fluoroscopy Guidance for Peripheral and Central Lung Lesions

Case Medical Research ◽

10.31525/ct1-nct04194333 ◽

2019 ◽

Author(s):

Keyword(s):

Real Time ◽

Computer Tomography ◽

Diagnostic Yield ◽

Cone Beam ◽

Lung Lesions ◽

Electromagnetic Navigational Bronchoscopy ◽

Cone Beam Computer Tomography ◽

Fluoroscopy Guidance

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Practicability and Diagnostic Yield of One-Stop Stroke CT with Delayed-Phase Cardiac CT in Detecting Major Cardioembolic Sources of Acute Ischemic Stroke

Clinical Neuroradiology ◽

10.1007/s00062-021-01003-7 ◽

2021 ◽

Author(s):

Friederike Austein ◽

Matthias Eden ◽

Jakob Engel ◽

Annett Lebenatus ◽

Naomi Larsen ◽

...

Keyword(s):

Diagnostic Yield ◽

Early Stage ◽

Recurrent Stroke ◽

Cardiac Computed Tomography ◽

Standard Of Care ◽

Routine Work ◽

One Stop ◽

Work Up ◽

Delayed Phase ◽

Multimodal Ct

Abstract Purpose Recurrent stroke is considered to increase the incidence of severe disability and death. For correct risk assessment and patient management it is essential to identify the origin of stroke at an early stage. Transthoracic echocardiography (TTE) is the initial standard of care for evaluating patients in whom a cardioembolic source of stroke (CES) is suspected but its diagnostic capability is limited. Transesophageal echocardiography (TEE) is considered as gold standard; however, this approach is time consuming, semi-invasive and not always feasible. We hypothesized that adding a delayed-phase cardiac computed tomography (cCT) to initial multimodal CT might represent a valid alternative to routine clinical echocardiographic work-up. Material and Methods Patients with suspected acute cardioembolic stroke verified by initial multimodal CT and subsequently examined with cCT were included. The cCT was evaluated for presence of major CES and compared to routine clinical echocardiographic work-up. Results In all, 102 patients with suspected acute CES underwent cCT. Among them 60 patients underwent routine work-up with echocardiography (50 TTE and only 10 TEE). By cCT 10/60 (16.7%) major CES were detected but only 4 (6.7%) were identified by echocardiography. All CES observed by echocardiography were also detected by cCT. In 8 of 36 patients in whom echocardiography was not performed cCT also revealed a major CES. Conclusion These preliminary results show the potential diagnostic yield of delayed-phase cCT to detect major CES and therefore could accelerate decision-making to prevent recurrence stroke. To confirm these results larger studies with TEE as the reference standard and also compared to TTE would be necessary.

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