Closed percutaneous pleural biopsy. A lost art in the new era

OBJECTIVE: To assess the association between size and number of biopsy specimens obtained by percutaneous closed pleural biopsy, with overall diagnostic yield in general, and histopathological evidence of tuberculosis pleurisy, in particular.

METHODS: One hundred and forty-three patients, with a high index of clinically having tuberculous pleurisy, were referred to the respiratory division of Mubarak Al-Kabeer Hospital in Kuwait during a 9-year period (January 1999 to December 2007). All subjects with exudative lymphocytic predominant effusion underwent percutaneous closed pleural biopsy, looking for tuberculous granulomas. The clinical diagnosis and pathological characteristics (number and size of biopsy samples) were analyzed.

RESULTS: Overall diagnostic yield of percutaneous closed pleural biopsy in all cases was noticed to be 52%. The larger biopsy sample size of 3 mm and more, and the higher number of specimens (>/=4) were significantly associated with an increased diagnostic yield for tuberculous pleurisy (p=0.007 and 0.047).

CONCLUSION: Obtaining 4 or more biopsy samples, and larger specimens of 3mm and more for histopathological evaluation, through percutaneous pleural biopsy, results in a better diagnostic yield for tuberculous pleurisy. Obtaining 4 or more biopsy samples, and larger specimens of 3mm and more for histopathological evaluation, through percutaneous pleural biopsy, results in a better diagnostic yield for tuberculous pleurisy.