title: Percutaneous multiple-site parietal pleural biopsy: description and evaluation of a new and safe technique.
abstract: OBJECTIVE
  (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.
  
  
  METHODS
  Prospective interventional study.
  
  
  METHODS
  University teaching hospital.
  
  
  METHODS
  Consecutively referred for evaluation of exudative PE.
  
  
  METHODS
  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.
authors.affiliation: Department of Medicine, Faculty of Medicine, Kuwait University, Safat, Kuwait. bsuthaman@hotmail.com
authors.forename: Babu
authors.initials: B
authors.lastname: Uthaman
authors.forename: Nasser
authors.initials: N
authors.lastname: Behbehani
authors.forename: Adnan
authors.initials: A
authors.lastname: Abal
authors.forename: John
authors.initials: J
authors.lastname: Madda
authors.forename: Siddiq
authors.initials: S
authors.lastname: Khan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000295:instrumentation / Q000379:methods*; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D010994:Pleura / Q000473:pathology*; D010996:Pleural Effusion / Q000473:pathology*; D011446:Prospective Studies