The effectiveness of percutaneous blind pleural biopsy in the era of modern biopsy techniques (pleuroscopy, VATS) - the experience of the university clinical center in the developing country

A. Zecevic*^a (Dr), B. Ilic^b (Dr), S. Popevic^b (Dr), M. Grujic^a (Dr), M. Omcikus^b (Dr)

^a Clinic for Pulmonology, University Clinical Center of Serbia, Belgrade, SERBIA ; ^b Faculty of Medicine, University of Belgrade, Clinic for Pulmonology, University Clinical Center of Serbia, Belgrade, SERBIA

* zecevic92andrej@gmail.com

Introduction: Exudative pleural effusion is the most common manifestation of various lung and pleura infections, as well as primary or secondary malignancies involving the pleura. Percutaneous pleural biopsy represents the first line in the differential diagnosis of the etiology of pleural disease, in patients in whom thoracentesis did not give a definitive answer.

Methods: We performed a retrospective study, in which we included patients who underwent percutaneous pleural biopsy in our center between July 2020. and March 2022. We analysed the effectiveness of this procedure, regarding clarifying the definitive etiology of pleural effusion, as well as additional diagnostic procedures, if they were necessary.

Results: In that period, in the Clinic for Pulmonology, University Clinical Center of Serbia, that is the largest pulmonological center in our country, a percutaneous pleural biopsy was performed on a total of 135 patients with exudative pleural effusion. Malignant tumor as a cause of pleural effusion was found in 61 (45.2%) cases, of which primary lung tumors 42 (31.1%), malignant mesothelioma 10 (7.4%), and tumors of other origins 9 (6.7%). In 7 cases, there was the tuberculous pleuritis (5.2%). In 14 of 67 patients (10.4%) the diagnosis was made by one of the other methods (bronchoscopy 5, VATS biopsy 6, EGDS biopsy 2, pericardiocentesis 1). Twenty-seven patients died before any other diagnostic procedure or didn't come to the control examination. In 10 patients, the primary tumor of another localization (outside of the lung or pleura) was radiographically verified, or they already had a history of malignancy.

Conclusion: Given the significant differences in cost, safety, the extent of necessary training of medical staff, and also 50.4% sensitivity, percutaneous biopsy still has significant use in diagnosing the etiology of pleural effusion, especially in the developing countries, where diagnostic procedures like pleuroscopy and VATS are often unavailable.

Disclosure of funding source(s): none