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Canadian Respiratory Journal
Volume 20 (2013), Issue 5, Pages 362-366
http://dx.doi.org/10.1155/2013/731352
Original Article

Role of Blind Closed Pleural Biopsy in the Management of Pleural Exudates

Marco F Pereyra,1 Esther San-José,2 Lucía Ferreiro,1 Antonio Golpe,1 José Antúnez,3 Francisco-Javier González-Barcala,1 Ihab Abdulkader,3 José M Álvarez-Dobaño,1 Nuria Rodríguez-Núñez,1 and Luis Valdés1

1Servicios de Neumología, Complejo Hospitalario Universitario de Santiago, A Coruña, Spain
2Análisis Clínicos, Complejo Hospitalario Universitario de Santiago, A Coruña, Spain
3Anatomía Patológica, Complejo Hospitalario Universitario de Santiago, A Coruña, Spain

Copyright © 2013 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

INTRODUCTION: The performance of blind closed pleural biopsy (BCPB) in the study of pleural exudates is controversial.

OBJECTIVE: To assess the diagnostic yield of BCPB in clinical practice and its role in the study of pleural exudates.

METHODS: Data were retrospectively collected on all patients who underwent BCPB performed between January 1999 and December 2011.

RESULTS: A total of 658 BCPBs were performed on 575 patients. Pleural tissue was obtained in 590 (89.7%) of the biopsies. A malignant pleural effusion was found in 35% of patients. The cytology and the BCPB were positive in 69.2% and 59.2% of the patients, respectively. Of the patients with negative cytology, 21 had a positive BCPB (diagnostic improvement, 15%), which would have avoided one pleuroscopy for every seven BCPBs that were performed. Of the 113 patients with a tuberculous effusion, granulomas were observed in 87 and the Lowenstein culture was positive in an additional 17 (sensitivity 92%). The overall sensitivity was 33.9%, with a specificity and positive predictive value of 100%, and a negative predictive value of 71%. Complications were recorded in 14.4% of patients (pneumothorax 9.4%; chest pain 5.6%; vasovagal reaction, 4.1%; biopsy of another organ 0.5%).

CONCLUSIONS: BCPB still has a significant role in the study of a pleural exudate. If an image-guided technique is unavailable, it seems reasonable to perform BCPB before resorting to a pleuroscopy. These results support BCPB as a relatively safe technique.