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

Introduction 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 multi-region 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 CT-guided pleural biopsy (CTGPB). Methods We performed a retrospective multi-centre 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. Results 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% 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%). 93 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%). Conclusion CTGPB and USGPB are safe and accurate for diagnosis of pleural malignancy in cases where LAT is not available or feasible.