Pleural Biopsy in Evaluation of Malignant Pleural Effusion- A Review

Malignant pleural effusion (MPE) is one of the common presentation of many carcinoma including lung, breast and lymphomas. It is very important to make an etiological diagnosis of the MPE cases without any delay as treatment depends on its cause. Cytopathological examination of fluid for malignant cells is the easiest and most sensitive method for detecting malignant pleural effusion (MPE). Despite cytology being a sensitive test, many patients remain undiagnosed, then there is a need of histopathological examination of pleura. Invasive procedures like Closed pleura biopsy (CPB) or thoracoscopy was recommended. CPB was earlier considered an investigation of choice in cases of undiagnosed pleural effusion with good efficacy Since the emergence of medical thoracoscopy (MT), use of CPB in the diagnosis of cytology negative MPE is gradually declining. However, due to the high cost and challenges associated with the surgery, thoracoscopy is only used in a restricted number of cases. CPB is less reliable than cytopathological testing of fluid or MT in determining MPE. Yet, it is a simple procedure with little procedure -related complication. The purpose of this article is to assess the clinical presentation and approach to MPE, as well as the role of CPB in diagnosing MPE and to investigate the benefits and drawbacks of CPB.”