Comparison of Needle Biopsy With Cytologic Analysis for the Evaluation of Pleural Effusion: Analysis of 414 Cases

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We retrospectively studied the results from thoracenteses and needle biopsies of the pleura performed in 414 patients with pleural effusions between 1973 and 1982. The final causes of effusion were malignant disease in 281 patients (67.9%) and nonmalignant disease in 133 (32.1%). The presence of pleural malignant disease was established by cytologic study in 162 patients (57.6%), by needle biopsy in 123 (43%), and by either cytologic analysis or biopsy in 182 (64.7%). In only 7.1% of the 281 patients with malignant pleural effusions did biopsy reveal malignant disease when the results of cytologic study were negative for malignant disease. Nearly half of the patients with lymphoma had lymphocytosis of the pleural fluid, but neither this finding nor the lymphocytic pleuritis noted on biopsy was diagnostic of lymphomatous involvement of the pleura. Among the patients with malignant mesothelioma, thoracotomy was necessary to confirm the diagnosis in 60.9%. In the patients with nonmalignant diseases, with the exception of six with tuberculous pleurisy, pleural biopsy was nondiagnostic even though the causes of pleural effusion were apparent from the clinical features. The causes of pleural effusion remained unknown in 82 patients (19.8%). Pleural biopsy failed to provide adequate tissue in 55 patients (13.3%). This study shows that cytologic analysis has a higher sensitivity (P<0.001) than needle biopsy for diagnosing malignant pleural effusions. The value of needle biopsy is limited in establishing the cause of pleural effusion that results from either malignant or nonmalignant disease, with the exception of tuberculous pleurisy. We suggest that thoracentesis and cytologic study without biopsy be the initial diagnostic approach to pleural effusions in patients in whom tuberculous pleurisy is not clinically suspected.

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MATERIAL AND METHODS

From 1973 through 1982, 1,644 patients underwent thoracenteses at the thoracic disease outpatient clinic of our institution. Among these patients were 414 who also underwent needle biopsy of the pleura, with either a Cope or an Abrams needle. Thirty of these patients underwent needle biopsy on two occasions; thus, a total of 444 biopsies were performed.

The case records of the 414 patients who underwent needle biopsy were reviewed in detail; clinical aspects, results of histologic examination of

RESULTS

Of the 414 patients who underwent pleural biopsies, 241 were men and 173 were women. Their average age was 59.6 years (range, 18 to 87 years). The initial diagnoses on the basis of the pleural biopsy alone were malignant disease in 123 patients (29.7%) and nonmalignant disease in 236 (57%). In 55 patients (13.3%), the needle biopsy failed to yield an adequate quantity of pleural tissue for analysis. The final etiologic diagnoses for the pleural effusions, established from clinical features or

DISCUSSION

This report includes more patients with malignant pleural effusion who underwent pleural biopsy than any previously published study of which we are aware. Cytologic analysis was positive for malignant disease in 58% of our patients; the highest positive rate (81%) was for pleural effusion due to metastatic breast carcinoma. Cytologic analysis of pleural fluid is reported to be diagnostic of malignant disease in 9% to 80% of cases, but in most series the success rate is about 60%.16, 17, 25, 33,

ACKNOWLEDGMENT

We are indebted to Dr. Leo F. Black for his invaluable suggestions in the preparation of this article and to Mr. Kenneth P. Offord for providing assistance with the statistical analysis. We gratefully acknowledge the help provided by Ms. Pamela J. Miller and Ms. Linda K. Smith in acquisition of data.

REFERENCES (60)

  • PF Jenkins et al.

    Non-Hodgkin's lymphoma, chronic lymphatic leukemia and the lung

    Br J Dis Chest

    (1981)
  • HW Berger et al.

    Tuberculous pleurisy

    Chest

    (1973)
  • JJ Gunnels

    Perplexing pleural effusion

    Chest

    (1978)
  • N DeFrancis et al.

    Needle biopsy of the parietal pleura: a preliminary report

    N Engl J Med

    (1955)
  • C Cope

    New pleural biopsy needle: preliminary study

    JAMA

    (1958)
  • K Moghissi

    A new type of pleural biopsy instrument

    Br Med J

    (1961)
  • SJ Steel et al.

    Trephine biopsy of the lung and pleura

    Thorax

    (1969)
  • RJ Ballestero

    A new reliable instrument for pleural biopsy

    Chest

    (1972)
  • JP Anderson

    A modification of the Abrams's pleural biopsy punch

    Br J Dis Chest

    (1981)
  • JC Sibley

    A study of 200 cases of tuberculous pleurisy with effusion

    Am Rev Tuberc

    (1950)
  • H Levine et al.

    Diagnosis of tuberculous pleurisy by culture of pleural biopsy specimen

    Arch Intern Med

    (1970)
  • PC Elmes et al.

    The clinical aspects of mesothelioma

    Q J Med

    (1976)
  • DD Von Hoff et al.

    Diagnostic reliability of needle biopsy of the parietal pleura: a review of 272 biopsies

    Am J Clin Pathol

    (1975)
  • J Scerbo et al.

    A prospective study of closed pleural biopsies

    JAMA

    (1971)
  • C Boutin et al.

    Thoracoscopy in malignant pleural effusions

    Am Rev Respir Dis

    (1981)
  • RL Cowie et al.

    Pleural biopsy: a report of 750 biopsies performed using Abrams's pleural biopsy punch

    S Afr Med J

    (1983)
  • IPF Mungall et al.

    Multiple pleural biopsy with the Abrams needle

    Thorax

    (1980)
  • H Levine et al.

    Blunt-end needle biopsy of pleura and rib

    Arch Intern Med

    (1962)
  • L Scharer et al.

    Isolation of tubercle bacilli from needle biopsy specimens of parietal pleura

    Am Rev Respir Dis

    (1968)
  • DH Thompson et al.

    An open technique of pleural biopsy in the diagnosis of tuberculous effusions

    Ann R Coll Surg Engl

    (1979)
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