A decade of image-guided pleural biopsies: a multicentre retrospective study assessing diagnostic yield and complication rate

Pleural disease is common, with diagnostic options including pleural effusion cytology and pleural biopsy, either by local anaesthetic thoracoscopy (LAT) or image-guided biopsy. LAT facilitates multiregion sampling and simultaneous effusion management but may not be feasible with a loculated pleural space. Using long term local data, we assessed the diagnostic yield (DY) and complications associated with ultrasound-guided pleural biopsy (USGPB) and computed tomography-guided pleural biopsy (CTGPB).

We performed a retrospective multicentre cohort study across 6 hospitals, retrieving data regarding USGPB and CTGPB performed in these hospitals between 01/01/13 and 31/03/23 using study code and key word searches. Patient demographics, pathology, final diagnosis (by biopsy or consensus diagnosis), and complications were recorded.

A total of 194 CTGPBs were performed; 166/194 were diagnostic (DY 85.6%). 7/194 (3.6%) had a peri-procedural pneumothorax on CT, but none required intervention. For diagnosis of pleural malignancy, the sensitivity of CTGPB was 93.9% (95% confidence interval [CI]: 88.9%-97.0%), specificity 100% (89.1%-100%), positive predictive value (PPV) 100% (97.6-100%) and negative predictive value (NPV) 76.2 (63.7-85.4%). Ninty-three USGPBs were performed, all without post-procedural pneumothorax; 83/93 were diagnostic (DY: 89.2%). For pleural malignancy diagnosis, sensitivity of USGPB was 94.1% (95% CI: 84.5%-97.7%), specificity 100% (59.0%-100%), PPV 100% (94.6%-100%) and NPV 60.0% (37.5%-76.5%).

CTGPB and USGPB are safe and accurate for diagnosis of pleural malignancy in cases where LAT is not available or feasible.