Study on feasibility and utility of frozen section analysis of medical thoracoscopic pleural biopsies in undiagnosed exudative pleural effusion

S. Cladius^a (Dr), GS. Grace^a (Dr), N. Vennilavan^a (Dr), U. Bhattu^a (Dr), A. Ingle^a (Dr), V. Balasubramanian*^a (Dr)

^a Yashoda Hospitals, Hyderabad, INDIA

* drviswes89@gmail.com

BACKGROUND:

Medical thoracoscopy for undiagnosed exudative pleural effusions allows both tissue diagnosis and pleurodesis to be achieved at same setting. Frozen section analysis of biopsy samples is routinely performed by pathologists in oncology domain. The aim of the study is to evaluate feasibility and accuracy of frozen section analysis of pleural biopsies taken during medical thoracoscopy and examine its utility in decision making for performing on table pleurodesis and / or indwelling pleural catheter.

METHODOLOGY:

Twenty consecutive patients with undiagnosed exudative pleural effusion after at least one diagnostic thoracocentesis were recruited for this prospective study . Medical thoracoscopic pleural biopsies from all patients were subjected to frozen section analysis by pathologist.

RESULTS:

Frozen section of pleural biopsy was possible in all twenty thoracoscopic procedures intraoperatively with a mean reporting time of 12.12 minutes from the receipt of the specimen by the pathologist. Total number of pleural biopsies were limited to 3 samples following positive report. Frozen section at the time of thoracoscopy identified 7 cases as benign (35%) and 13 cases as malignant (65%). Amongst patient with malignancy on frozen section, talc pleurodesis was performed in 6 (46.1%) and indwelling pleural catheter was performed in 4 (30.7%) patients on table. The final diagnosis based on paraffin sections was maligant in eleven cases (55%) and benign in nine cases (45%). Both the sensitivity and specificity of frozen section in diagnosing benign pleural pathology was 100%. The sensitivity and specificity of frozen section in diagnosing malignant pleural pathology was 100% and 77.8% respectively.

CONCLUSION:

Frozen section of medical thoracoscopic pleural biopsy is feasible and has the good sensitivity and specificity for diagnosing benign pleural pathology. It aids in decreasing the procedural time, limit number of pleural biopsies and may facilitate decision making for on table pleurodesis and/or IPC.

Disclosure of funding source(s): none