Pleural diseases involve the parietal and visceral pleura and can be either inflammatory or malignant origin, resulting in pleural effusion. A needle biopsy of the pleura is performed to evaluate and exclusion of infectious etiologies such as tuberculosis malignant disease. Various biopsy techniques are available to diagnose pleural disease. The newer techniques include image-guided and thoracoscopic biopsy provide better diagnostic accuracy.
Use (see Chapter 13, "Respiratory, Metabolic and Acid " “base Disorders, " ¯ for more information about pleural effusions)
Evaluation of lymphocyte-predominant pleural effusion
Diagnosis of an exudative pleural effusion that is undiagnosed after cytologic examination (diagnostic in 40 " “75% of cases)
Recurrent pleural effusion of unknown etiology, pleural mass, or thickening
Interpretation
The test is positive for tumor in approximately 6% of malignant mesotheliomas and approximately 60% of other cases of malignancy.
The test is positive for tubercles in two thirds of cases on first biopsy, with increased yield on second and third biopsies; therefore, repeat biopsy if suspicious clinically. Acid-fast stain or granulomas can be found in 50 " “80% of cases, and culture of biopsy material for TB is positive in ≤75% of cases. A fluid culture alone establishes a diagnosis of TB in 25% of cases.