Comparative diagnostic efficacy of ultrasound-guided, medical thoracoscopic, and blind pleural biopsy in tuberculous pleurisy

Background Pleural biopsy (PB) procedures to diagnose tuberculous pleurisy may be blind, ultrasound-guided, or medical thoracoscopic (BPB, USPB, and MTPB, respectively). However, the diagnostic efficacy of the three methods has not been comprehensively and systematically elaborated locally or abroad. This retrospective study compared the diagnostic efficacy and safety of BPB, USPB, and MTPB. Methods A retrospective analysis included 333 patients (BPB =84, USPB =97, MTPB =152). Propensity score matching (PSM) generated 60, 77, and 78 matched pairs (USPB vs . BPB, USPB vs . MTPB, BPB vs . MTPB). Sensitivity, specificity, positive predictive value (PPV)/negative predictive value (NPV), and complications were analyzed. Results MTPB exhibited significantly higher sensitivity than USPB and BPB (all P 0.05). Conclusions MTPB is the optimal initial diagnostic method for suspected tuberculous pleurisy due to superior sensitivity. USPB, offering moderate accuracy with lower invasiveness, is a viable alternative if MTPB is unavailable. BPB should only be considered in resource-limited settings, with explicit recognition of its elevated false-negative risk necessitating rigorous clinical follow-up to prevent diagnostic delays. This study provides evidence-based guidance for selecting PB techniques.