Utility of closed pleural biopsy in the diagnosis of tuberculous pleural effusion

ABSTRACT

The present study was designed to evaluate the diagnostic yield and safety of closed pleural biopsy using Abram's needle in patients with suspected tuberculous pleural effusions. 115 patients [86 males and 29 females] with suspected tuberculous pleural effusion were retrospectively observed in the period from January 2004 to December 2006. All patients were clinically evaluated and in addition to routine laboratory investigations, chest X-ray and sputum for acid fast bacilli [AFB] were examined. Thoracocentesis, followed by closed pleural biopsy was performed in all patients in the same setting. A total of 2 - 3 pleural biopsy pieces were obtained in each patient and were sent for histopathological examination. Pleural fluid was examined for microbiology [Gram stain, Ziehl-Neelson stain], biochemistry [protein, LDH, sugar] and cytology [for malignant cells, total and differential cell count]. The analysis of pleural fluid showed exudative fluid in 111 patients [97%] and transudate in four patients [3%]. Histological analysis revealed caseous granulomatous inflammation in 47 patients [41%] and non-caseous granulomatous inflammation in 16 patients [14%] Non-specific inflammation was observed in 38 [33%] patients and malignancy in four patients [3%] and the biopsies were inadequate for examination in 10 patients [9%]. Out of the 115 patients, 92 were finally diagnosed as pleural TB in which histopathological examination aided in the diagnosis of 63 patients [69%]. The pleural fluid culture was positive in four patients [4.4%] and the direct AFB was positive in two patients [2.2%]. The procedure was well tolerated and complications were detected only in 11 patients. We concluded that closed pleural biopsy was a simple, safe, and effective method to rapidly diagnose pleural tuberculosis