CHEST
Original Research: Disorders of the PleuraPhysician-Based Ultrasound-Guided Biopsy for Diagnosing Pleural Disease
Section snippets
Materials and Methods
A retrospective review was undertaken of all thoracoscopies and pleural biopsies performed at the Oxford Centre for Respiratory Medicine between January 2010 and July 2013. All the patients with planned pleural biopsies and those patients in whom thoracoscopy could not be performed (“failed” thoracoscopy), and so converted to ultrasound-guided biopsy, were further assessed. The histologic results were analyzed to determine the yield of pleural tissue. The patients were followed up in a
Patients
Over the 3-year period, a total of 252 thoracoscopies were attempted. Of these, 13 (5.2%) were not successful and, hence, were converted on table to image-guided, cutting-needle biopsy. An additional 37 preplanned, ultrasound-guided biopsies were also conducted. These planned biopsies were undertaken in cases in which either there was a small or heavily septated effusion, adhered lung (visualized as a lack of pleural sliding on thoracic ultrasound), or patient frailty. Therefore, a total of 50
Discussion
We have demonstrated that real-time, ultrasound-guided pleural biopsies conducted by respiratory physicians have a high diagnostic yield for both planned biopsies and on-table conversion to biopsy after attempted thoracoscopy. The 94.0% yield for planned biopsy is comparable to the high yield described by radiologists for ultrasound- and CT image-guided biopsies.11
The yield for the 13 patients who were converted to ultrasound-guided biopsy after failed thoracoscopy was 84.6%. This is a
Acknowledgments
Author contributions: R. J. H. and N. M. R. had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. R. J. H., J. P. C., A. M., and N. M. R. contributed to the study concept; R. J. H., J. P. C., M. N., M. M., I. P., A. M., and N. M. R. contributed to data analysis; M. N., H. R., N. H., and I. P. contributed to data collection; A. A. and F. V. G. contributed to analysis of CT images; and R. J. H., J. P. C., A.
References (11)
- et al.
Medical thoracoscopy, results and complications in 146 patients: a retrospective study
Respir Med
(1998) - et al.
Ultrasound-guided pleural biopsy with Tru-Cut needle
Chest
(1991) - et al.
Introduction and methods: British Thoracic Society pleural disease guideline 2010
Thorax
(2010) - et al.
Prospective evaluation of flex-rigid pleuroscopy for indeterminate pleural effusion: accuracy, safety and outcome
Respirology
(2007) New challenges in medical thoracoscopy
Respiration
(2011)
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2022, American Journal of MedicineCitation Excerpt :It also avoids the radiation exposure associated with CT guidance. Ultrasound-guided pleural biopsy has a diagnostic yield as high as 94%.17 CT-guided pleural biopsy is used in small cytology-negative pleural effusions when lung sliding is not present, and the diagnostic yield of CT-guided biopsy ranges from 82.4% to 96.5%.4
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2021, Clinics in Chest MedicineCitation Excerpt :Traditionally, image-guided biopsies have been performed by radiologists, but in the United Kingdom, owing to the widespread use of point-of-care TUS, many specialist pleural centers are now able to offer TUS-guided pleural biopsies as day cases. These are performed by physicians and can reduce the load on radiologists with improved diagnostic pathway times whilst maintaining diagnostic accuracy.39,44,45 One advance of pulmonologists becoming competent in TUS-guided biopsies is the option of performing a combination pleural aspiration and biopsy at their first out-patient appointment becomes achievable in a “one-stop shop” pleural clinic.40
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FUNDING/SUPPORT: This research was supported by the National Institute for Health Research Oxford Biomedical Research Centre, The Oxford University Hospitals Trust, University of Oxford.
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