title: A study to compare the diagnostic efficacy of closed pleural biopsy with that of the thoracoscopic guided pleural biopsy in patients of pleural effusion.
abstract: BACKGROUND
  The diagnostic approach to exudative pleural effusion remains an underappreciated aspect of modern thoracic medicine. 15-20% of the pleural effusions remain undiagnosed. The most efficient approach to pleural exudates remains uncertain and controversial particularly if acquisition of pleural tissue is required. The clinician needs to consider various factors when confronted with the choice between closed pleural biopsy (CPB) and thoracoscopy. Hence this study was planned to compare the diagnostic efficacy of CPB and Thoracoscopic pleural biopsy (TPB).
  
  
  METHODS
  This was a prospective interventional study in patients of exudative pleural effusion. CPB was performed by Cope's biopsy needle. Then inspection of the pleural cavity was performed by single port rigid thoracoscope (KARL, STORZ TELECAM DX II 20 2330 20) with viewing angle of zero (0) degrees and biopsy taken from the diseased or unhealthy parietal pleura. Accordingly we compared the results of CPB and TPB.
  
  
  RESULTS
  46 Patients underwent this study. In all 46 patients both CPB and TPB were performed. TPB was diagnostic in 36 cases (78.2%) while CPB was diagnostic only in 10 cases i.e. 21.7%. 10 (21,7%) cases remained undiagnosed. On thoracoscopic examination 30 patients were having nodularity, 25 (54.3%) were having adhesions and 20 (43.5%) were having hyperemia. 79.3% of the patients with nodularity turned out to be malignant and 71.4% of patients with adhesions and hyperemia tubercular.
  
  
  CONCLUSIONS
  TPB has much greater diagnostic efficacy than CPB.
authors.affiliation: Department of Pulmonary Medicine, King George' Medical University, Lucknow, Uttar Pradesh, India.
authors.forename: Ashwini Kumar
authors.initials: AK
authors.lastname: Mishra
authors.affiliation: Department of Pulmonary Medicine, King George' Medical University, Lucknow, Uttar Pradesh, India.
authors.forename: Sanjeev Kumar
authors.initials: SK
authors.lastname: Verma
authors.affiliation: Department of Pulmonary Medicine, King George' Medical University, Lucknow, Uttar Pradesh, India.
authors.forename: Surya
authors.initials: S
authors.lastname: Kant
authors.affiliation: Department of Pulmonary Medicine, King George' Medical University, Lucknow, Uttar Pradesh, India.
authors.forename: Ram Awadh
authors.initials: RA
authors.lastname: Kushwaha
authors.affiliation: Department of Pulmonary Medicine, King George' Medical University, Lucknow, Uttar Pradesh, India.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Garg
authors.affiliation: Department of Pulmonary Medicine, King George' Medical University, Lucknow, Uttar Pradesh, India.
authors.forename: Santosh
authors.initials: S
authors.lastname: Kumar
authors.affiliation: Department of Pulmonary Medicine, King George' Medical University, Lucknow, Uttar Pradesh, India.
authors.forename: Ved
authors.initials: V
authors.lastname: Prakash
authors.affiliation: Department of Pulmonary Medicine, King George' Medical University, Lucknow, Uttar Pradesh, India.
authors.forename: Ajay
authors.initials: A
authors.lastname: Verma
authors.affiliation: Department of Pathology, King George' Medical University, Lucknow, Uttar Pradesh, India.
authors.forename: Mala
authors.initials: M
authors.lastname: Sagar
keywords: Malignancy; pleural diseases; thoracoscopic pleural biopsy; tuberculosis