Chest
Volume 67, Issue 5, May 1975, Pages 536-539
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Clinical Investigations
Efficacy of Pleural Needle Biopsy and Pleural Fluid Cytopathology in the Diagnosis of Malignant Neoplasm Involving the Pleura

https://doi.org/10.1378/chest.67.5.536Get rights and content

A comparison was made of the efficacy of pleural needle biopsy and pleural-fluid cytopathology in the diagnosis of pleural tumor in a group of 271 patients. A malignant tumor involving the pleura was present in 95 cases. Needle biopsy alone provided a diagnosis of tumor in 53 instances, and cytopathologic preparations were diagnostic in 69 patients. A diagnosis was established on either the biopsy or cytopathology, or both, in 86 cases (90 percent). These results indicate the value of using both biopsy and fluid cytology in the evaluation of pleural effusion, which often is due to involvement of the pleura by malignant neoplasm.

Section snippets

Methods

Three hundred and forty-eight consecutive patients who underwent needle biopsy of the pleura between 1966 and 1972 were identified in the surgical pathology files of The Johns Hopkins Hospital. The biopsies were performed with the Abrams pleural punch biopsy needle. Of these, cytopathologic examination of pleural fluid had also been performed, and follow-up information was available on 271 patients. This group forms the basis of the study.

The clinical records of these 271 patients were reviewed

Results

The causes of the pleural effusions of the 271 patients are shown in Table 1. A malignant tumor involving the pleura was present in 95 cases. The effusions were due to various non-neoplastic diseases in 176 intsances. The most common of these was tuberculosis (56 cases), followed closely by congestive heart failure (46) and bacterial pneumonia (45).

The types of neoplasms involving the pleura in the 95 patients are listed in Table 2. The lung and breast were the most common primary sites. In 17

Discussion

The findings of this study confirm the usefulness of closed needle biopsy of the pleura and of cytologic study of pleural fluid in the diagnosis of malignant tumor involving the pleura. Although biopsy or cytology alone yielded definite diagnoses in a relatively high percentage of cases, the two used together provided a diagnosis in 90 percent of the patients.

Considering the focal nature of pleural involvement by metastic tumor, it is not surprising that the success in diagnosis for biopsy

Conclusion

This report has compared the efficacy of pleural needle biopsy and pleural fluid cytopathology in the diagnosis of pleural neoplasm. Cytologic studies alone yielded a higher percentage of cancer diagnoses than did the biopsies alone. A diagnosis was established in 90 percent of the patients with pleural tumor when both studies were performed. These findings indicate the value of utilizing these techniques concomitantly in the evaluation of patients with pleural effusion, which in the adult is

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Supported by U. S. Public Health Service Training Grant No. GM-00415 and by ELC Grant Nos. NIH-N01-CB92172 and NIH-N01-CN-45037.

Manuscript received June 21; revision accepted September 12.

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