Role of thoracoscopic pleural biopsy in evaluation of pleural effusion

Context: Evaluation of a patient with pleural effusion involves clinical, radiological and cytological evaluation of pleural fluid and histological evaluation of pleural biopsy. It is not always possible to identify the exact etiology of pleural effusion based on cytological examination alone. Pleural biopsy is sensitive in up to 91% of cases. Aims: The Aim of the paper is to study the diagnostic yield of thoracoscopic pleural biopsy and to ascertain the etiology of pleural effusions. Materials and Methods: The material for this study is pleural biopsies received in the department of pathology in a tertiary care hospital. A total of 103 biopsies were studied in three years (2013-2015). Biopsies were fixed in buffered formalin and routinely processed. A panel of histochemical stains and immuno histochemical markers were done when required. Statistical Analysis used: None. Results: A total of 103 biopsies were studied. M: F ratio is 2.1:1. Youngest patient was 16 years and oldest was 80 years. Most common diagnosis was tuberculosis, diagnosed in 32 cases (32.6%), other lesions diagnosed were acute infection 10 cases (10.2%), chronic inflammation 24 cases (24.5%), adenocarcinoma 13 (13.2%), squamous cell carcinoma 5 (5.1), lymphoma 5 (5.1%), mesothelioma four cases(4.08%), one each of small cell carcinoma, poorly differentiated carcinoma, solitary fibrous tumour, xanthogranulomatous inflammation, extra medullary hematopoiesis, benign mesothelial hyperplasia constituting (1.0%) each. Four biopsies were inadequate and excluded from the study. Conclusions: Thoracoscopic pleural biopsy has a very high sensitivity 91% and a specificity of 100% in diagnosing pleural effusions. It is a safe procedure. Material obtained can be used for ancillary techniques in cases of diagnostic dilemmas.