Physician-based ultrasound-guided biopsy for diagnosing pleural disease.
BACKGROUND
Definitive diagnosis of pleural disease (particularly malignancy) depends upon histologic proof obtained via pleural biopsy or positive pleural fluid cytology. Image-guided sampling is now standard practice. Local anesthetic thoracoscopy has a high diagnostic yield for malignant and nonmalignant disease, but is not always possible in frail patients, if pleural fluid is heavily loculated, or where the lung is adherent to the chest wall. Such cases can be converted during the same procedure as attempted thoracoscopy to cutting-needle biopsy. This study aimed to determine the diagnostic yield of a physician-led service in both planned biopsies and cases of failed thoracoscopy.


METHODS
This study was a retrospective review of all ultrasound-guided, cutting-needle biopsies performed at the Oxford Centre for Respiratory Medicine between January 2010 and July 2013. Histologic results were assessed for the yield of pleural tissue, final diagnosis, and clinical follow-up in nonmalignant cases.


RESULTS
Fifty ultrasound-guided biopsies were undertaken. Overall, 47 (94.0%) successfully obtained sufficient tissue for histologic diagnosis. Of the 50 biopsy procedures, 13 were conducted after failed thoracoscopy (5.2% of 252 attempted thoracoscopies over the same time period); of these 13, 11 (84.6%) obtained sufficient tissue. Thirteen of 50 biopsy specimens (26.0%) demonstrated pleural malignancy on histology (despite previous negative pleural fluid cytology), while 34 specimens (68.0%) were diagnosed as benign. Of the benign cases, 10 were pleural TB, two were sarcoidosis, and 22 were benign pleural thickening. There was one "false negative" of mesothelioma (median follow-up, 16 months).


CONCLUSIONS
Within this population, physician-based, ultrasound-guided, cutting-needle pleural biopsy obtained pleural tissue successfully in a high proportion of cases, including those of failed thoracoscopy.
The Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, England; Oxford Respiratory Trials Unit, Churchill Hospital, Oxford, England. Electronic address: robhallifax@yahoo.com.
Robert J
RJ
Hallifax
The Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, England; Oxford Respiratory Trials Unit, Churchill Hospital, Oxford, England.
John P
JP
Corcoran
Department of Radiology, Churchill Hospital, Oxford, England.
Asia
A
Ahmed
University of Oxford Clinical Medical School, Oxford, England.
Myura
M
Nagendran
University of Oxford Clinical Medical School, Oxford, England.
Hussam
H
Rostom
University of Oxford Clinical Medical School, Oxford, England.
Neelam
N
Hassan
University of Oxford Clinical Medical School, Oxford, England.
Mahiben
M
Maruthappu
The Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, England; Oxford Respiratory Trials Unit, Churchill Hospital, Oxford, England.
Ioannis
I
Psallidas
The Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, England; Oxford Respiratory Trials Unit, Churchill Hospital, Oxford, England.
Ari
A
Manuel
Department of Radiology, Churchill Hospital, Oxford, England.
Fergus V
FV
Gleeson
The Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, England; Oxford Respiratory Trials Unit, Churchill Hospital, Oxford, England.
Najib M
NM
Rahman
D000328:Adult; D000368:Aged; D001707:Biopsy, Needle / Q000379:methods*; D005260:Female; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010820:Physicians; D010994:Pleura / Q000473:pathology*; D010995:Pleural Diseases / Q000175:diagnosis* / Q000473:pathology; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013906:Thoracoscopy / Q000379:methods*; D018084:Ultrasonography, Interventional / Q000379:methods*