Undiagnosed exudative pleural effusion is a considerable challenge and often needs further histological study for a definitive etiological diagnosis.
The objective of this study was to compare the diagnostic yield of needle pleural biopsy, semirigid thoracoscopy and fiberoptic bronchoscopy in the diagnosis of pleural effusion. Methods: From July 2012 to April 2019, 336 consecutive patients with pleural effusions of unknown origin who underwent pleural biopsy with different procedures including needle pleural biopsy, semirigid thoracoscopy and fiberoptic bronchoscopy at a university hospital were analyzed retrospectively. All procedures were performed under local anesthesia with a single point of entry.
Results: The diagnostic yields of needle pleural biopsy, semirigid thoracoscopy and fiberoptic bronchoscopy were 63.0, 98.6 and 93.0%, respectively. The diagnostic sensitivities for malignancy with the three procedures were 3.7, 19.3 and 16.3%, respectively. Thus, the overall diagnostic rate and the diagnostic sensitivity for malignancy with needle pleural biopsy were significantly lower than that with semirigid thoracoscopy or fiberoptic bronchoscopy. The time needed to use the needle pleural biopsy, semirigid thoracoscopy and fiberoptic bronchoscopy was 26.1±8.6 min, 75.5±14.9 min and 80.4±15.6min, respectively, and the surgical cost for each operation was 31.7±3.6 dollars, 243.5±18.6 dollars and 241.9±21.3 dollars, respectively. Therefore, the operative time and the surgical cost of needle pleural biopsy were less than for semirigid thoracoscopy or fiberoptic bronchoscopy. The patients requested significantly less pain medication for the needle pleural biopsy than for the semirigid thoracoscopy or fiberoptic bronchoscopy.
Conclusions: This study demonstrates that semi-rigid thoracoscopy and fiberoptic bronchoscopy have a similar superior diagnostic yield for pleural effusions, and chest pain is the common adverse effect. Needle pleural biopsy has a modest yield but is less expensive and time consuming.
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