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Percutaneous Multiple-Site Parietal Pleural Biopsy^*

Description and Evaluation of a New and Safe Technique

^* From the Department of Medicine (Drs. Uthaman, Behbehani, and Abal), Faculty of Medicine, Kuwait University, Safat, Kuwait; the Microbiology Department (Dr. Khan), Chest Diseases Hospital, Kuwait City, Kuwait; and the Pathology Department (Dr. Madda), Amiri Hospital, Kuwait City, Kuwait.

Correspondence to: Babu Uthaman, DM, Department of Medicine, Faculty of Medicine, Kuwait University, PO box 24923, 13110 Safat, Kuwait; e-mail: bsuthaman{at}hotmail.com

Study objectives: (1) To describe a new percutaneous pleural biopsy technique to obtain multiple-site parietal pleural biopsy specimens in patients with pleural effusion (PE), and (2) to evaluate its effectiveness and safety compared to current techniques.

Design: Prospective interventional study.

Setting: University teaching hospital.

Patients: Consecutively referred for evaluation of exudative PE.

Intervention: With the patient in a semirecumbent position, a 9F sheath was inserted by the Seldinger technique into the pleural cavity on the midaxillary line under local anesthesia and fluoroscopic guidance. An 8F bioptome was introduced through it, and biopsy specimens were taken from several sites on the costal and diaphragmatic pleura. After biopsy, PE was completely evacuated, and the sheath was removed.

Results: During the 2-year pilot study, we procured, on average, 14 adequate pleural specimens from each of the 28 patients (age range, 15 to 81 years) on the first attempt. Histopathologic examination revealed tuberculous pleuritis (18 patients), metastatic adenocarcinoma (1 patient), and nonspecific pleuritis (9 patients). Postprocedure, 25 patients had rapid symptomatic improvement without recurrence of PE. No major complications occurred during or after the procedure (mean follow-up period, 2 years).

Conclusions: Our new biopsy procedure can be performed easily, safely, and with increased diagnostic sensitivity and patient comfort. Unlike other biopsy techniques, it provides adequate multiple-site pleural biopsy specimens, in all cases, on the first attempt without any morbidity and mortality. It has a therapeutic potential to provide rapid symptomatic relief and treatment by pleurodesis. We recommend this procedure for patients whose conditions remain undiagnosed after undergoing needle biopsy or for those who cannot tolerate it, before considering more aggressive diagnostic interventions. This is the best alternative when thoracoscopy or thoracotomy are not available or when patients are at high risk for complications from them.

Key Words: bioptome • granuloma • histopathology • malignant • parietal pleural biopsy • percutaneous pleural biopsy • pleural effusion • pleuritis • tuberculous