Diagnostic Utility of Closed Needle Pleural Biopsy in Exudative Pleural Effusions

Background: Diagnosing exudative pleural effusions is often challenging. Newer techniques like pleuroscopy are costly and complex to perform, making its availability questionable. Aims & Objectives: To study the diagnostic utility of closed needle pleural biopsy in exudative pleural effusions. Methods: It was a prospective study, in which closed needle pleural biopsy using Cope’s needle was done in patients with exudative pleural effusion. The samples obtained were evaluated using histopathological and microbiological tests and the results were compared with that of pleural fluid analysis. Results: 240 patients with exudative pleural effusion were included. 218 (91%) patients had tubercular effusion while 22 (9%) had effusion secondary to malignancy. Fluid was straw-colored in 154 (64%) patients, empyema in 48 (20%), and hemorrhagic in 38 (16%). AFB culture was positive in 152 (63%) patients on pleural fluid, compared to 209 (87%) patients on pleural biopsy. On pleural biopsy histopathological examination, granuloma was seen in 184 (76%) patients. Pleural fluid cytology suggested malignancy in 2 patients (0.8%), while this was seen in 14 patients (5.8%) on pleural biopsy. Major complications were pain (38%) and pneumothorax (16%). Only 1 patient with pneumothorax required intervention with intercostal drain. The sensitivity for AFB culture positivity with pleural biopsy and pleural fluid was 95.8% & 69.7% respectively (p<0.05), while sensitivity of pleural fluid and pleural biopsy for detection of malignancy was 9% and 63% respectively (p<0.05). Conclusion: Closed needle pleural biopsy is a quick and reliable method for diagnosing exudative pleural effusions, with low rates of complication.