Diagnostic yield and safety of medical thoracoscopic versus computed tomography-guided percutaneous tru-cut pleural biopsy

Background Pleural effusion is considered the most common presentation of pleural diseases; approximately 50% of cases of pleural effusion remain undiagnosed following thoracentesis. Purpose To compare between the diagnostic accuracy, safety, and complications of medical thoracoscopic (MT) versus computed tomography-guided (CTG) tru-cut pleural biopsy. Patients and methods The patients with unexplained exudative pleural effusion were classified into two groups: MT or CTG tru-cut pleural biopsy. The pleural biopsies obtained during both procedures were sent for mycobacterial culture and histopathology. Results Complications of MT were pain in six (20%), prolonged air leak in two (6.7%), and subcutaneous emphysema in two (6.7%) patients, whereas the complications of CTG pleural biopsy were pain in three (10%) and pneumothorax in two (6.7%) patients, with no significant difference. Length of hospital stay was 5.13±1.63 in MT and 2.83±1.23 in CTG group; the difference was highly significant (P Conclusion MT and CTG pleural biopsy are safe techniques with high diagnostic yield and low complication rate. However, MT was slightly more sensitive than CTG biopsy besides its therapeutic role. On the contrary, CTG biopsy has a shorter hospital stay than thoracoscopic technique. Proper selection of the procedure will increase the diagnostic value of each procedure.