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Percutaneous multiple-site parietal pleural biopsy: description and evaluation of a new and safe technique.

Abstract：

STUDY OBJECTIVES:(1) To describe a new percutaneous pleural biopsy technique to obtain multiple-site parietal pleural biopsy specimens in patients with pleural effusion (PE), and (2) to evaluate its effectiveness and safety compared to current techniques. DESIGN:Prospective interventional study. SETTING:University teaching hospital. PATIENTS:Consecutively referred for evaluation of exudative PE. INTERVENTION:With the patient in a semirecumbent position, a 9F sheath was inserted by the Seldinger technique into the pleural cavity on the midaxillary line under local anesthesia and fluoroscopic guidance. An 8F bioptome was introduced through it, and biopsy specimens were taken from several sites on the costal and diaphragmatic pleura. After biopsy, PE was completely evacuated, and the sheath was removed. RESULTS:During the 2-year pilot study, we procured, on average, 14 adequate pleural specimens from each of the 28 patients (age range, 15 to 81 years) on the first attempt. Histopathologic examination revealed tuberculous pleuritis (18 patients), metastatic adenocarcinoma (1 patient), and nonspecific pleuritis (9 patients). Postprocedure, 25 patients had rapid symptomatic improvement without recurrence of PE. No major complications occurred during or after the procedure (mean follow-up period, 2 years). CONCLUSIONS:Our new biopsy procedure can be performed easily, safely, and with increased diagnostic sensitivity and patient comfort. Unlike other biopsy techniques, it provides adequate multiple-site pleural biopsy specimens, in all cases, on the first attempt without any morbidity and mortality. It has a therapeutic potential to provide rapid symptomatic relief and treatment by pleurodesis. We recommend this procedure for patients whose conditions remain undiagnosed after undergoing needle biopsy or for those who cannot tolerate it, before considering more aggressive diagnostic interventions. This is the best alternative when thoracoscopy or thoracotomy are not available or when patients are at high risk for complications from them.

journal_name

Chest

journal_title

Chest

authors

Uthaman B,Behbehani N,Abal A,Madda J,Khan S

doi

10.1378/chest.125.5.1776

subject

Has Abstract

pub_date

2004-05-01 00:00:00

pages

1776-82

issue

eissn

0012-3692

issn

1931-3543

pii

S0012-3692(15)32175-9

journal_volume

125

pub_type

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Percutaneous multiple-site parietal pleural biopsy: description and evaluation of a new and safe technique.