https://doi.org/10.4081/monaldi.2025.3361
Comparative study between ultrasound-guided closed pleural biopsy and thoracoscopic pleural biopsy in undiagnosed exudative pleural effusions
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Published: 18 March 2025
Pleural biopsies are often required to establish a diagnosis in exudative pleural effusions, which remain undiagnosed after initial pleural fluid analysis. Medical thoracoscopy offers a high diagnostic yield but has limited availability in resource-constrained settings. This prospective comparative study evaluated the diagnostic yield between ultrasound-guided closed pleural biopsy and medical thoracoscopy among patients with undiagnosed exudative pleural effusions with pleural-based lesions at least 10 mm in size. Both groups achieved an equal diagnostic yield of 92% despite fewer biopsy specimens being taken in the ultrasound-guided biopsy group (4.52±0.65) compared to the thoracoscopic group (7.8±1) (p<0.0001). In conclusion, ultrasound-guided closed pleural biopsy is a suitable alternative to medical thoracoscopy in patients with undiagnosed exudative pleural effusion having pleural thickening or nodularity of at least 10 mm in size, in terms of having a similar diagnostic yield as compared to medical thoracoscopy.
Downloads
Hooper C, Lee YC, Maskell N. Investigation of a unilateral pleural effusion in adults: British Thoracic Society pleural disease guideline 2010. Thorax 2010;65:ii4-17. DOI: https://doi.org/10.1136/thx.2010.136978
Light RW, Lee YCG. Textbook of pleural diseases. Boca Raton, FL, USA: CRC Press; 2016.
Villena Garrido V, Cases Viedma E, Fernández Villar A, et al. Recommendations of diagnosis and treatment of pleural effusion. Update. Arch Bronconeumol 2014;50:235-49. DOI: https://doi.org/10.1016/j.arbr.2014.04.007
Mungall IP, Cowen PN, Cooke NT, et al. Multiple pleural biopsy with the Abrams needle. Thorax 1980;35:600-2. DOI: https://doi.org/10.1136/thx.35.8.600
Niu XK, Bhetuwal A, Yang HF. CT-guided core needle biopsy of pleural lesions: evaluating diagnostic yield and associated complications. Korean J Radiol 2015;16:206-12. DOI: https://doi.org/10.3348/kjr.2015.16.1.206
M. Sakuraba, K. Masuda, A. Hebisawa, et al, Diagnostic value of thoracoscopic pleural biopsy for pleurisy under local anaesthesia. ANZ J Surg 2006;76:722-4. DOI: https://doi.org/10.1111/j.1445-2197.2006.03839.x
Maturu VN, Dhooria S, Bal A, et al. Role of medical thoracoscopy and closed blind pleural biopsy in undiagnosed exudative pleural effusions: a single center experience of 348 patients. J Bronchology Interv Pulmonol 2015;22:121-9. DOI: https://doi.org/10.1097/LBR.0000000000000145
Durgeshwar G, Mohapatra PR, Bal SK, et al. Comparison of diagnostic yield and complications in ultrasound-guided closed pleural biopsy versus thoracoscopic pleural biopsy in undiagnosed exudative pleural effusion. Cureus 2022;14:e23809. DOI: https://doi.org/10.7759/cureus.23809
Rahman NM, Ali NJ, Brown G, et al. Local anaesthetic thoracoscopy: British Thoracic Society Pleural Disease Guideline 2010. Thorax 2010;65:ii54-60. DOI: https://doi.org/10.1136/thx.2010.137018
Metintas M, Ak G, Dundar E, et al. Medical thoracoscopy vs CT scan-guided Abrams pleural needle biopsy for diagnosis of patients with pleural effusions: a randomized, controlled trial. Chest 2010;137:1362-8. DOI: https://doi.org/10.1378/chest.09-0884
Koegelenberg CF, Diacon AH. Pleural controversy: close needle pleural biopsy or thoracoscopy-which first? Respirology 2011;16:738-46. DOI: https://doi.org/10.1111/j.1440-1843.2011.01973.x
Murthy V, Bessich JL. Medical thoracoscopy and its evolving role in the diagnosis and treatment of pleural disease. J Thorac Dis 2017;9:S1011-21. DOI: https://doi.org/10.21037/jtd.2017.06.37
Roberts ME, Rahman NM, Maskell NA, et al. British Thoracic Society guideline for pleural disease. Thorax 2023;78:s1-42. DOI: https://doi.org/10.1136/thorax-2022-219784
Bibby AC, Maskell NA. Pleural biopsies in undiagnosed pleural effusions; Abrams vs image-guided vs thoracoscopic biopsies. Curr Opin Pulm Med 2016;22:392-8. DOI: https://doi.org/10.1097/MCP.0000000000000258
Lin Z, Wu D, Wang J, et al. Diagnostic value of ultrasound-guided needle biopsy in undiagnosed pleural effusions: a systematic review and metaanalysis. Medicine 2020;99:e21076. DOI: https://doi.org/10.1097/MD.0000000000021076
Metintas M, Yildirim H, Kaya T, et al. CT scan-guided Abrams’ needle pleural biopsy versus ultrasound-assisted cutting needle pleural biopsy for diagnosis in patients with pleural effusion: a randomized, controlled trial. Respiration 2016;91:156-63. DOI: https://doi.org/10.1159/000443483
Thomas R, Roy B, Maldonado F, et al. Management of malignant pleural effusions—what is new. Semin Respir Crit Care Med 2019;40:323-39. DOI: https://doi.org/10.1055/s-0039-1698285
Chang CH, Ost DE. Malignant pleural disease: a pragmatic guide to diagnosis. Curr Opin Pulm Med 2022;28:282-7. DOI: https://doi.org/10.1097/MCP.0000000000000877
Koegelenberg CF, Bolliger CT, Theron J, et al. Direct comparison of the diagnostic yield of ultrasound-assisted Abrams and Tru-Cut needle biopsies for pleural tuberculosis. Thorax 2010;65:857-62. DOI: https://doi.org/10.1136/thx.2009.125146
Rahman NM, Gleeson FV. Image-guided pleural biopsy. Curr Opin Pulm Med 2008;14:331-6. DOI: https://doi.org/10.1097/MCP.0b013e3282fe9a04
Zhang Y, Tang J, Zhou X, et al. Ultrasound-guided pleural cutting needle biopsy: accuracy and factors influencing diagnostic yield. J Thorac Dis 2018;10:3244-52. DOI: https://doi.org/10.21037/jtd.2018.05.94
Metintas M, Ak G, Metintas S, et al. Prospective study of the utility of computed tomography triage of pleural biopsy strategies in patients with pleural diseases. J Bronchology Interv Pulmonol 2019;26:210-8. DOI: https://doi.org/10.1097/LBR.0000000000000559
Bugalho A, Ferreira D, Dias SS, et al. The diagnostic value of transthoracic ultrasonographic features in predicting malignancy in undiagnosed pleural effusions: a prospective observational study. Respiration 2014;87:270-8. DOI: https://doi.org/10.1159/000357266
Metintas M, Ak G, Yildirim H, et al. Image-assısted pleural needle biopsy or medical thoracoscopy: which method for which patient? A Randomızed Controlled Trial. Chest 2024;166:405-12. DOI: https://doi.org/10.1016/j.chest.2024.03.038
Chang DB, Yang PC, Luh KT, et al. Ultrasound-guided pleural biopsy with TruCut needle. Chest 1991;100:1328-33. DOI: https://doi.org/10.1378/chest.100.5.1328
Ethics Approval
How to Cite
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.