Medical thoracoscopic versus ultrasound guided transthoracic pleural needle biopsy in diagnosis of pleural lesions

Abstract

Background: Medical thoracoscopy increases the diagnostic yield in patients with undiagnosed pleural effusion. Ultrasound guided pleural biopsies are safe procedures with high diagnostic yields. Objective: To compare safety and efficacy of medical thoracoscopic versus ultrasound guided transthoracic needle biopsy in the diagnosis of pleural lesions. Patients and methods: 40 patients with undiagnosed pleural lesions were divided into 2 groups. After clinical, radiological examination and laboratory investigations; pleural biopsies were taken by ultrasound guided needle biopsy and medical thoracoscopy in group I and II respectively. Results: Complications in group I were in the form of pain in 2 patients (10%), hemoptysis in 1 (5%), while complications in group II were pain in 4 (20%), failure of the lung to expand in 5 (25%), pneumothorax in 5 (25%) and wound infection in 3 patients (15%). Final histopathological diagnosis in group I was parapneumonic effusion in 3 patients (15%), inflammatory lung lesion in 1 (5%), pleural fibroma in 2 (10%), malignant mesothelioma in 4 (20%), sarcoma in 1 (5%), adenocarcinoma in 1 (5%), squamous cell carcinoma in 4 (20%), and metastatic adenocarcinoma in 1 (5%). Final histopathological diagnosis in group II was pleural TB in 4 patients (20%), inflammatory lung lesions in 2 (10%), malignant mesothelioma in 6 (30%), adenocarcinoma in 5 (25%), and metastatic adenocarcinoma in 2 (10%). The diagnosed cases were 17 (85%) and 19 (95%) in groups I and II respectively. Conclusions: Medical thoracoscopy is an important diagnostic method for the diagnosis of undiagnosed pleural effusion while it is concluded that US guided pleural biopsy is more useful in cases of pleural lesions without effusion.

Keywords

• Pleural effusion
• Medical thoracoscopy
• Ultrasound guided biopsy