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Value of closed pleural biopsy in diagnosis of pleural effusion.Przegl
Lek. 2005;62(12):1325-7.
The aim of the
study was to assess closed pleural biopsy (CPB) as a diagnostic method
of pleural effusion. CPB using Cope needle was performed in 62
patients, proceeded by ultrasound examination. It helped to obtain
specimen for histological and microbiological examination even with
cases of small amount of fluid. In all 62 patients CPB enabled to
diagnose 13 cases with neoplasmatic effusions (majority being
adenocarcinomas) and 16 cases of tuberculosis in histological and/or
microbiological examination. There were 33 cases with non-specific
inflammatory changes. In 7 patients we confirmed neoplastic pleural
infiltrates in cytological examination of pleural effusion. In 26
patients videothoracoscopy (VTS) was carried out and 20 of those had
post-inflammatory changes. In 4 cases, however we confirmed
neoplasmatic effusions and in next 2 cases--tuberculosis. Closed
pleural biopsy proves to be an efficient method in diagnosis of
Tuberculosis and malignant pleural effusions. However, in 23% of cases
with post-inflammatory changes, malignancy and tuberculosis were
undiagnosed. This in turn implicates the necessity for further
diagnostic procedures including VTS.
Diffuse
malignant pleural mesothelioma.Kyobu
Geka. 2007 ;60(1):35-9
Malignant
pleural mesothelioma is an uncommon neoplasm that caused 647 deaths in
Japan in 2004. The incidence of the disease is increasing and is
estimated to reach its peak in 2025. We reviewed the clinical features
in 11 consecutive patients with pathologically confirmed diffuse
malignant pleural mesothelioma in our institution from January 1997 to
December 2002. Of the 11 patients, 9 were male and 2 were female with
a mean age of 66 (range, 55 to 90) years. Symptoms included dyspnea in
4 patients, chest pain in 3, dyspnea plus chest pain in 2, and cough
in 2. Median period between symptom onset and presentation was 1
(range, 0 to 6) month. A history of asbestos exposure was identified
in 3 patients and suspected in 5. A definitive diagnosis was made by
closed pleural biopsy in 8 patients, pleural fluid cytology in 2, and
autopsy in 1. Histological subtypes included epithelioid in 6
patients, sarcomatoid in 2, biphasic in 1, and unknown in 2.
International Mesothelioma Interest Group (IMIG) staging included
stage II in 6 patients, stage III in 3, and stage IV in 2. Median
period between presentation and diagnosis was 1 (range, 0 to 22)
month. Treatment included intrapleural chemotherapy in 4 patients,
extrapleural pneumonectomy in 3, pleural drainage in 2, and best
supportive care in 2. During the follow-up period, 9 patients died and
2 survived. Median survival time after diagnosis was 3 (range, 0 to
51) months. Of the 11 patients, 7 (64%) died within 6 months after the
first presentation, and only 1 (9%) lived longer than 2 years after
diagnosis.
Current
problems in the diagnosis of malignant pleural mesothelioma.
Kyobu Geka. 2007 Jan;60(1):14-8.
The diagnosis
of malignant pleural mesothelioma (MPM) is challenging although MPM is
highly aggressive tumor. The current diagnostic gold standard is
principally based on light microscopic examination of hematoxylin-eosin
and immunohistochemical stains of large tissue sections. However,
pathological diagnosis of MPM and classification of histological
findings into 1 of the 3 subtypes (epithelial, sarcomatoid, biphasic)
are difficult. We studied correlation between initial and final
histological diagnosis retrospectively from the records of 21 cases
with MPM from 1989 to 2005. The diagnosis of MPM was confirmed by
histopathological examination of pleural tissue samples obtained by
closed biopsy under computed tomography (CT) or ultrasonography-guided
(5 cases), by biopsy under thoracoscopy with local anesthesia (9), by
open biopsy via thoracotomy (2), and by video-assisted thoracoscopic
surgery (VATS) [5] . Pleural biopsy under those diagnostic methods led
to initial diagnosis of MPM in 15 of 21 cases (71.4%) . In 6 cases
(28.6%) , initial diagnosis of MPM were not confirmed because of
missing malignant tissue (1 case) and relatively small and sarcomatous
element (5). In 2 cases examined by closed biopsy and in 3 examined by
thoracoscopy under local anesthesia, initial diagnosis of MPM were not
confirmed. To get the accurate diagnosis of MPM, obtaining large
tissue samples in the initial examination by less invasive
thoracoscopy is recommended.
Diagnostic value of
thoracoscopic pleural biopsy for pleurisy under local anaesthesia.
ANZ J Surg. 2006 Aug;76(8):722-4
BACKGROUND: We
find pleural effusion in clinical practice frequently. However, it is
difficult to make a diagnosis definitively by thoracocentesis or
closed pleural biopsy. We directly examine the thoracic cavity by
thoracoscopy under local anaesthesia, carry out pleural biopsy and
make a definitive pathological diagnosis in pleurisy. METHOD: A
retrospective study of 138 patients who had been diagnosed by
thoracoscopy in our hospital was carried out between January 1995 and
January 2005. RESULTS: The patients were 114 men and 24 women, ranging
in age from 21 to 85 years, with a mean of 59 years. The right side
was involved in 83 patients and the left side in 55. The operations
took 11-145 min, with a mean of 46 min. Thoracoscopy directly without
thoracocenteses was carried out in 28 of 138 patients. Lung cancer
with pleural dissemination was diagnosed in 27, malignant pleural
mesothelioma in 10, tuberculous pleurisy in 32, non-specific pleurisy
in 58, other tumour in 2 and pyothorax in 9 patients. The overall
diagnostic efficacy was 97.1% (134/138). The diagnostic efficacy in
the cases of carcinoma was 92.6% (25/27), in malignant pleural
mesothelioma it was 100% (10/10) and in tuberculosis it was 93.8%
(30/32). No major complications occurred during the examination.
CONCLUSION: Pleural biopsy by thoracoscopy under local anaesthesia
should be actively carried out in patients with pleurisy, because the
technique has a high diagnostic rate and can be easily and safely
carried out.
Diagnostic
yield of closed pleural biopsy in exudative pleural effusion.Saudi
Med J. 2003 Mar;24(3):282-6.
OBJECTIVE:
Closed pleural biopsy is known to be diagnostic in approximately 75%
of pleural effusion undiagnosed by thoracocentesis or pleural fluid
evaluation. The purpose of this study was to determine the efficacy of
closed pleural biopsy in a Saudi tertiary care teaching hospital.
METHODS: We retrospectively reviewed the diagnostic utility of all
closed pleural biopsies performed from January 1988 to December 1997
at the King Fahad National Guard Hospital, Riyadh, Kingdom of Saudi
Arabia. RESULTS: One hundred and twenty-two pleural biopsies were
performed in 116 patients using cope needle in 39, Abram's needle in
82, and Trucut needle in one patient. Twelve cases were excluded due
to transudative effusion (N=6) and obtaining no pleural tissue (N=6).
Specific diagnoses were obtained in 54 cases giving a diagnostic yield
of 49.1%. Of these 10 revealed neoplasia, 35 tuberculosis, and 9
empyema. A non-specific diagnosis was obtained in 56 (50.9%) cases.
CONCLUSION: By closed pleural biopsy 49.1% of undiagnosed exudative
pleural effusions could be diagnosed. This shows that closed pleural
biopsy is still of value as a diagnostic procedure, and should be
carried out prior to invasive procedures such as thoracoscopy or open
pleural biopsy.
Closed pleural
needle biopsy: predicting diagnostic yield by examining pleural fluid
parameters.Respir
Med. 2002 Nov;96(11):890-4
OBJECTIVE: Pleural fluid parameters that predict a diagnostic closed
pleural needle biopsy were investigated. DESIGN: A retrospective
analysis. SETTING: The Institute of Pulmonology, Hadassah University
Hospital. PATIENTS AND METHODS: Forty-four patients who underwent
closed pleural needle biopsies were included in this study. Pleural
fluid values of protein, glucose, lactate dehydrogenase (LDH), pH, and
white blood cell count with differential cell counts, from patients
with diagnostic and non-diagnostic pleural biopsies were compared.
RESULTS: Thirteen patients (29%) had diagnostic biopsies. Malignancy
was identified in 10 patients (23%), of whom 70% had adenocarcinoma.
Three other patients had non-malignant specific diagnosis. LDH levels
in pleural fluid from patients with diagnostic pleural biopsy were
higher than in patients with non-diagnostic pleural biopsies (1436 +/-
333 U l(-1) vs. 775 +/- 109 U l(-1); P < 0.05). LDH levels less than
510 U l(-1) were highly predictive of a negative biopsy (negative
predictive value of 86.6%). Follow up revealed malignancy including
mesothelioma and lymphoma, in 10 of 30 (33%) patients with
non-diagnostic biopsies, and one patient died of unrelated cause,
while the pleural effusion either resolved, remained stable or an
alternative benign process was identified in 19 patients (63%).
CONCLUSIONS: Low levels of LDH (< 510 U l(-1)) were highly predictive
of a negative pleural needle biopsy. Thus, LDH may serve as a useful
guide in deciding whether to perform closed pleural biopsy or to
proceed to thoracoscopically guided biopsy.
Diagnostic
value of medical thoracoscopy in pleural disease: a 6-year
retrospective study.Chest.
2002 May;121(5):1677-83.
STUDY
OBJECTIVES: Unlike thoracocentesis and closed pleural biopsy (CPB),
medical thoracoscopy permits biopsy with direct visualization. In a
6-year retrospective study of patients having undergone at least one
medical thoracoscopy, we analyzed the diagnostic yield of thoracoscopy
and its value in the management of pleural disease. SETTING/PATIENTS:
From January 1, 1989, to December 31, 1994, 168 medical thoracoscopies
were performed on 154 patients (123 men; mean age +/- SE, 61 +/- 1
years), of which 149 were diagnostic and 19 were indicated for
therapeutic assessment in malignant mesothelioma (MM). Prior to
thoracoscopy, at least one CPB had been performed in 120 of 149 cases,
yielding a diagnosis in 96 cases. RESULTS: Thoracoscopy challenged the
CPB-based diagnosis in 43 of 96 cases. In 66 cases of nonspecific
inflammation diagnosed by CPB, thoracoscopy revealed MM in 16 cases,
adenocarcinoma in 10 cases, undetermined carcinoma in 3 cases, and
pleural tuberculosis in 3 cases. In 18 cases in which the CPB
diagnosis was MM, thoracoscopy, performed for precise staging,
challenged the diagnosis in 4 cases. In 12 cases of carcinoma
diagnosed by CPB, thoracoscopy specified the histologic type in 7
cases. Thoracoscopic diagnoses were found to be erroneous in 10 of 149
cases, mainly owing to pleural adhesions that limited access to the
pleural cavity. There was one thoracoscopy-related death, one case of
sepsis, and six cases of empyema. CONCLUSIONS: Medical thoracoscopy
appears to be efficient and relatively safe in the management of
pleural disease. Pleural adhesions can lower its diagnostic value.
Determining
the optimal number of specimens to obtain with needle biopsy of the
pleura.Respir
Med. 2002 Jan;96(1):14-7
The aim of
this study was to define the number of pleural biopsy samples
necessary for optimum diagnostic performance and determine to what
extent they are complementary. Eighty-four closed pleural biopsies
were performed in our department between June 1996 and January 1998 on
55 males and 29 females with an average age of 64.4 +/- 16.7 years.The
study of the pleural fluid included: pH, biochemical testing of
pleura/serum (proteins, lactate dehydrogenase, glucose, cholesterol,
triglycerides, albumin and adenosine deaminase), haemogram, cytology
and microbiological testing (Gram-staining, aerobes, anaerobes and
mycobacteriae cultures). The biopsies were performed using a Cope
needle, with a total of five biopsies for each patient: four for
pathological examination (taken numerically in the order in which they
were performed: D1, D2, D3 and D4) and one for microbiological
testing. In those cases in which the diagnosis was uncertain or
effusion persisted, a thoracoscopy or thoracotomy was performed.There
were no significant differences in the diagnostic yield of each
individual sample (D1, D2, D3 and D4), but there were differences in
the sum of the samples, depending on the number of biopsies
performed.This was true for total group and the group with carcinomas,
but not for the group with tuberculosis. The increase in diagnostic
yield with the number of biopsies was more remarkable in the carcinoma
cases, where it increased by 35% when four biopsies were performed
(54% with one biopsy versus 89% with four biopsies, P < 0.002). In
conclusion, the diagnostic yield increased with the number of biopsy
samples in the total group and the group with malignancy but not in
the group with tuberculous effusions. The best diagnostic performance
for malignant pathology was obtained with four samples. In pleural
tuberculosis, the diagnostic yield did not increase with more biopsy
samples. One high quality sample should be enough to obtain a
diagnosis.
Blind
pleural biopsy using a Tru-cut needle in moderate to large pleural
effusion--an experience.Singapore
Med J. 1998 May;39(5):196-9
BACKGROUND:
Pleural biopsy is invaluable for the etiological diagnosis of pleural
diseases in the presence of an exudative pleural effusion.
Conventionally, pleural biopsy is either performed with the Cope's or
the Abrams pleural biopsy needles. A few investigators have used the
Tru-cut biopsy needle with or without ultrasound guidance. We report
our experience in performing closed pleural biopsy using a Tru-cut
needle without ultrasound guidance in moderate to large exudative
pleural effusion. We used a perpendicular approach to biopsy the
pleura instead of the tangential approach described earlier. METHODS:
Closed Tru-cut biopsy was performed in 27 consecutive patients with
exudative pleural effusion who volunteered to undergo the procedure.
The biopsy specimen was sent for histopathology. Pleural fluid
analysis and other relevant investigations required to obtain a
specific diagnosis were carried out. RESULTS: A specific diagnosis of
tuberculosis was obtained on histopathology of pleural tissue in 12
out of 16 patients (diagnostic yield 75%) and in 5 out of 7 patients
with malignancy (diagnostic yield 71%). Among the other 4 patients,
other causes of exudative pleural effusion were detected in 3 and in 1
patient, no specific diagnosis could be made, despite extensive
investigation. CONCLUSION: Closed pleural biopsy using a Tru-cut
needle is effective for the specific diagnosis of exudative pleural
effusion. The use of a perpendicular approach to biopsy the pleura
does not seem to increase the complication in moderate to large
pleural effusion.
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