Trends in pleural biopsies between 1996 and 2006 at a tertiary medical center

Introduction: To determine the cause of an exudative pleural effusion, clinicians may choose one of the three types of pleural biopsies-blind, image-guided, or surgical biopsies-depending on the extent of pleural involvement and the available expertise and technology. The purpose of this study was to examine the trends in the type of pleural biopsies performed between 1996 and 2006 and to assess the diagnostic sensitivity of the 3 aforementioned types of pleural biopsy. Methods: This was a retrospective study of all patients who underwent a pleural biopsy at a large teaching hospital between January 1, 1996, and December 31, 2006. Patients were identified by reviewing databases for surgical pathology and hospital discharge. The final diagnosis was determined by conducting a detailed chart review. We examined the trend in pleural biopsies from 1996 and 2006. We also compared the disease-specific sensitivity of blind, image-guided and surgical biopsies. Results: Of the 174 pleural biopsy specimens identified, 103 (59.1%) were blind, 38 (21.8%) were image guided (ultrasound and computed tomography), and 33 (18.9%) were surgical (video-assisted thoracoscopic surgery and open surgical). The proportion of blind pleural biopsies performed declined from 77.7% in 1996 to 26.6% in 2006 (P < 0.0001). During the same period, the proportion of image-guided biopsy rose from 7.4% to 53.3% (P < 0.001). The sensitivity of blind, image-guided and surgical biopsy was 42%, 78.7%, and 92.8%, respectively. Conclusions: The number of blind pleural biopsies performed by pulmonary fellows declined substantially between 1996 and 2006, with an increasing trend toward image-guided biopsy.