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Ultrasound-guided pleural biopsy
1Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
2Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa; Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, DST-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Cape Town, South Africa
Eurasian Journal of Pulmonology 2023; 25(1): 1-11 DOI: 10.14744/ejp.2021.9621
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A pleural exudate that remains undiagnosed after a combined clinical assessment, thoracentesis, and imaging requires a pleural biopsy for a definitive diagnosis. Thoracoscopy is often the first method of choice to obtain tissue as it offers greater sensitivity and there is a perception of less risk. However, with imaging guidance, closed pleural biopsy is a safe, affordable, and effective alternative to diagnose all forms of pleural disease. Ultrasound (US) has several benefits when compared with computed tomography for image-guided biopsy, as it is widely available, can be performed bedside, and does not expose the patient to radiation. If performed in optimal conditions, a transthoracic US-guided closed pleural biopsy can yield results comparable to those of thoracoscopy and a marked reduction in the complication rate versus blind biopsy. Abrams and Tru-Cut needles are the most widely used for a closed pleural biopsy. Either may be used with real-time image guidance or with a free-hand image-assisted technique to harvest up to 6 separate tissue samples. The needle choice will depend on the morphology of the lesion observed on imaging. The Tru-Cut is generally preferred for mass lesions of the pleura or pleura that is >20 mm in thickness, and the Abrams for pleural thickening of <20 mm or radiologically normal pleura. A transthoracic US may be used to detect, rule out, and prevent complications, such as bleeding, solid organ injury, or pneumothorax. The ability to perform thoracic US is a necessary skill in current respiratory practice, and US-guided closed pleural biopsy has a critical role in diagnosis.