Comparison between bronchoscopy, closed (Abram's) and medical thoracoscopic pleural biopsies in undiagnosed pleural effusions

Abstract

Background: Medical Thoracoscopy is gaining interest among the pulmonologists. But the non-availability of the procedure in all hospitals, high cost and non-availability of expert clinicians and staff are the main problems experienced in a developing countries

Aims: 1. To compare the diagnostic yield of bronchoscopic,closed pleural& thoracoscopic biopsies in undiagnosed pleural effusions.

2. To see whether combined bronchoscopy & closed pleural biopsy will be sufficient or not, in diagnosing pleural effusion where medical thoracoscopy is not available.

Methodology: A prospective observational study among 25 patients, admitted at our centre with undiagnosed exudative pleural effusion, s. Closed pleural biopsy, medical thoracoscopy and then 48 hours later bronchoscopy were done in all. The results and complications of the procedures were recorded and analysed.

Results: Out of the 25 patients, we could attain a diagnosis in 21 cases. Among them 16 had malignancy and 5 had tuberculosis. The overall sensitivity of the three procedures are as follows: closed pleural biopsy- 28.5%, bronchoscopy- 14.2%, medical thoracoscopy- 95.2%, combined pleural biopsy & bronchoscopy- 42.8%.The complication rate was lowest for bronchoscopy (4%), followed by medical thoracoscopy (8%) and closed pleural biopsy (16%).

Conclusion: Medical thoracoscopy is a comparatively safe procedure, having the highest diagnostic yield among three studied procedures in the evaluation of undiagnosed exudative pleural effusions When bronchoscopy is combined with closed pleural biopsy , the diagnostic yield is increased (than that of individual yield), but cannot be a substitute for medical thoracoscopy.