Diagnostic yield of closed pleural biopsy in exudative pleural effusion

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.