title: [THE ROLE OF CLOSED PLEURAL BIOPSY IN THE DIAGNOSIS OF TUBERCULOUS PLEURISY IN A POPULATION AT-RISK].
abstract: BACKGROUND
  Tuberculous pleurisy is the most common form of extrapulmonary tuberculosis, and a common cause of exudative pleural effusion. Closed pleural biopsy can be used for diagnosis. In recent years, more invasive methods are used for the diagnostic process in the western world. Contrary to the global trend, physicians at the Pulmonary Institute of the Soroka University Medical Center still perform a closed pleural biopsy as the first diagnostic step. In this article, we report our experience in the diagnosis of tuberculous pleurisy by closed pleural biopsy.
  
  
  METHODS
  A retrospective cohort analysis, conducted among patients, who were admitted for investigation of pleural effusion between 2008 and 2013, and underwent closed pleural biopsy with an Abrams needle in the evaluation of tuberculous pleurisy (n=25). Histopathological evidence of tuberculosis bacterium infection included a positive staining for acid-fast bacteria, identification of Langerhans giant cells, demonstration of chronic granulomatous inflammation or demonstration of granulomas with central necrosis in samples of pleural fluid or pleural biopsy.
  
  
  RESULTS
  Closed pleural biopsy was performed in 22/25 (88%) of patients. In 15/22 subjects (68%) histopathotogical evidence of tuberculous pleurisy was found. No significant complications were evident after the procedure. In addition, it was found that acid-fast bacteria in sputum samples, gastric fluid and pleural fluid is of very low diagnostic yield for the diagnosis of tuberculous pleurisy, while in cultures of sputum, gastric fluid or pleural fluid infection it was diagnosed in 27, 28 and 28% of subjects respectively.
  
  
  CONCLUSIONS
  In subjects with a high probability for tuberculous pleurisy, closed pleural biopsy using Abrams needle is available, inexpensive and has a good diagnostic yield and low complication rate. We believe that there is great importance in preserving the ability to perform a closed pleural biopsy in all. medical centers in Israel.
authors.forename: Lone
authors.initials: L
authors.lastname: Avnon
authors.forename: Or
authors.initials: O
authors.lastname: Kalchiem-Dekel
authors.forename: Aya
authors.initials: A
authors.lastname: Gozlan-Talmor
authors.forename: Fania
authors.initials: F
authors.lastname: Shimonovitch
authors.forename: Rotem
authors.initials: R
authors.lastname: Shalev
authors.forename: Nimrod
authors.initials: N
authors.lastname: Maimon
mesh_terms: D000328:Adult; D001707:Biopsy, Needle / Q000379:methods*; D057186:Comparative Effectiveness Research; D005260:Female; D006099:Granuloma / Q000209:etiology / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D010994:Pleura / Q000473:pathology*; D010996:Pleural Effusion / Q000175:diagnosis / Q000209:etiology; D015203:Reproducibility of Results; D014396:Tuberculosis, Pleural / Q000150:complications / Q000175:diagnosis / Q000473:pathology*