Efficacy and safety of pleural biopsy in aetiological diagnosis of pleural effusion

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S.K. Verma MD (TB & Chest Diseases)
Associate Professor
CSM Medical University

Address:
Lucknow
India

A.L. Dubey MD (TB)
MLN Medical College

Address:
Allahabad
India

P.A. Singh MD (Pathology)
Professor
MLN Medical College

Address:
Allahabad
India

S.L. Tewerson MD (Pathology)
Professor
MLN Medical College

Address:
Allahabad
India

Devashish Sharma Ph.D (Statistics)
Professor
MLN Medical College

Address:
Allahabad
India

Citation: S. Verma, A. Dubey, P. Singh, S. Tewerson & D. Sharma : Efficacy and safety of pleural biopsy in aetiological diagnosis of pleural effusion . The Internet Journal of Infectious Diseases. 2009 Volume 7 Number 1

Keywords: Pleural effusion | Pleural biopsy

Abstract

Study Objective: To find out the efficacy and safety of pleural biopsy in aetiological diagnosis of pleural effusion
Design: A prospective study. The efficacy and safety of pleural biopsy was studied in 50 patients of pleural effusion.
Setting: Out and In patients service of department of Tuberculosis & Chest Diseases, MLN Medical college Allahabad.
Patients: 50 patients who were above the age of 12 years were studied. Total no. of male patients was 34 and female were 16.
Results: Pleural biopsy made diagnosis of TB in 19 patients (out of 41 patients of tuberculosis), malignancy in 4 (out of 8), chronic non specific pleuritis in20, inadequate pleura in 5, acute pleuritis in 1 and no pleura in 1 patient. None of the patient developed any major complication.
Conclusion: Pleural biopsy is 46% sensitive and 100% specific for tuberculosis in one bite. Yield can be increased if more bites are obtained. Similarly sensitivity and specificity for malignancy is 50% and100%. And pleural biopsy is 100% safe procedure.

Introduction

Pleural effusion is a common chest problem, yet it is difficult to establish the aetiological diagnosis in as many as 20% cases, in spite of good history, thorough clinical , radiological and full examination of aspirated fluid. Prior to introduction of pleural biopsy the diagnosis of the cause of pleural effusion was more or less empirical. Closed pleural biopsy is a safe and simple alternative to open pleural biopsy1. Its utility in the diagnosis of pleural diseases has been the subject of many extensive report1-9. Despite of its worldwide acceptance and the widespread availability this investigation is not being used widely in India. We are reporting fifty cases in which this procedure formed an important part of the diagnostic evaluation, confirming both its usefulness and safety in the work up of patients of pleural effusion.

Material & Method

Patients Selection

Consecutive 50 patients of pleural effusion were studied, who were more than 12 years of age, irrespective of sex with no other systemic diseases. All patients underwent preliminary investigations as indicated by their clinical presentation, including haematological, radiological, bacteriological and biochemical.

Biopsy procedure

Pleural biopsy was done with Abraham's punch biopsy using standardizing technique10 with the variation that only one bite was taken instead of multiple bites. A chest skiagram was obtained in each case 4-6 hour after biopsy procedure, to identify the pneumothorax. All tissue obtained after biopsy were fixed in formalin and haematoxyline eosin (H & E) stained were prepared after taking thin section of the tissue.

Criteria for Histological Diagnosis

Tuberculosis inflammation: The section shows collection of epithelioid cells with or without caseation, surrounded by lymphocytes and giant cells of langhans type. Suggestive of tuberculosis inflammation: There is collection of epithelioid cells, without presence of giant cells of lengthens type. Chronic nonspecific inflammation: The section shows presence of chronic inflammatory cells e.g. lymphocytes, plasma cells and eosinophils with evidence of fibrosis. Acute inflammation: The section shows fibrous inflammatory exudates with infiltration of polymorphonuclear cells. Malignancy: The presence of groups of cells showing hyperchromatism and anaplasia is confirming of malignant infiltration of pleura. Fibrosis: The pleura show fibroblastic proliferation with collaginasation and occasional inflammatory cells. Normal pleura: consists of a membrane composed of loose or dense connective tissue contiguous to muscle lined by mesothelial cells. Inadequate: The biopsy was labeled inadequate where the tissue shows fibro muscular of fibro fatty tissue only

Results

50 patients above the age of 12 years were studied. Male were 34 and female were 16. Satisfactory tissue was obtained in 44 (88%) patients, 5 biopsy showed inadequate tissue while one patients showed no pleura. Of the 44 patients successfully biopsy, a definitive histopathological diagnosis was made in 24 (54.5%); 20 patients in addition has diagnosis of non specific inflammation. Details of pleural biopsy are listed in table 1.

Table 1: showing pleural biopsy finding

None of our patients developed pneumothorax following biopsy. No patients have significant bleeding. 42 patients complained of chest pain at site of biopsy.

Discussion

Since its original description in 1958 the technique of pleural biopsy has been adopted with no significant difference of safety and acceptable yield10. All reports are unanimous on its utility and safety. Critical patients have been evaluated without mishap. The diagnostic success rate has been reported to vary from 30% to 100% for different diseases with multiple bites2, 3,5,7,8. Our results are comparable to almost all previous studies. The factors which determine success include the number of samples taken2 and diffuseness of lesion in pleura. The safety of procedure has been emphasized. Common complications which are reported in the literature are pain at local site, bleeding and pneumothorax etc. The relative ease of performance, the obvious advantage over open biopsy and lack of any significant complication should prompt its more frequent use in Indian centers.

Corresponding Author

Dr. S. K. Verma,
Associate Professor,
Department of Pulmonary Medicine,
CSM Medical University,
UP, Lucknow, 226003
Telephone: 91- 0522- 2254346

References

1. De Francis et al. Needle biopsy of parietal pleura. The N Eng J of Med 1955;2: 948-949. (s)

2. Desmukh et al. Pleural Punch biopsy in tubercular pleural effusions to find out comparative value of single and multiple specimen. Indian J Tub 1972; 3: 95-100. (s)

3. Donohoe et al. Pleural biopsy as an aid in the aetiological diagnosis of pleural effusion. Ann Int Med 1958; 48: 344-362. (s)

4. Donohoe et al. Aspiration biopsy of parietal pleura. Am J Med 1857;2:883-893 (s)

5. Hanson. Pleural biopsy in diagnosis of thoracic diseases. BMJ 1962; 300-303. (s)

6. Hellar . Needle biopsy of parietal pleura. The New Eng J Med 1956; 11: 684-694. (s)

7. Hoff. Diagnostic reliability of needle biopsy of the parietal pleura. Am J clinical path1975; 64: 200-203. (s)

8. Leggat. Needle biopsy of parietal pleura in malignant diseases. BMJ 1959; 478-479. (s)

9. Levine. Tuberculous pleuritis, an acute illness-diagnosis by needle biopsy and acid fast stain. Am thoracic soc1962;68:127 (s)

10. Abrams LD. A pleural biopsy punch. The Lancet1958; 30-31. (s)

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