Comparative efficacy and complications of Transthoracic Ultrasound guided Pleural biopsy versus Medical thoracoscopic Pleural biopsy in Undiagnosed Exudative Pleural Effusion: Experience from a Tertiary Care Institute of Eastern India

Background: Approximately 20% of exudative pleural effusions remain undiagnosed even after diagnostic thoracentesis. In such situations, pleural biopsy is essential for establishing a diagnosis. Pleural biopsy can be obtained either through invasive procedures, such as medical or surgical thoracoscopy, or through semi-invasive techniques, such as closed pleural biopsy, with or without image guidance. This study compared the efficacy and complications of transthoracic ultrasound-guided versus medical thoracoscopic pleural biopsy for undiagnosed exudative pleural effusion. Methodology: This prospective observational comparative study included 110 patients who were randomly assigned to undergo either ultrasound-guided pleural biopsy (UPB) or medical thoracoscopic pleural biopsy (TPB) under local anesthesia. The specimens were sent for histopathological examination (HPE) and GeneXpert for Mycobacterium tuberculosis (CBNAAT). Results: Conclusive diagnosis was achieved in 96% of TPB cases and 95% of UPB cases. Malignancy predominated in TPB (56%), whereas tuberculosis in UPB (47%). Among the tuberculosis cases, CBNAAT was positive in 18 UPB and 12 TPB cases, with two rifampicin-resistant cases in each group. The mean hospital stay was longer in TPB (11.3 days) than in UPB (1.5 days), and complications were fewer in UPB. Conclusion: Both UPB and TPB can be used in undiagnosed pleural effusion cases. Although TPB is the gold standard for diagnosing pleural diseases, UPB is a less invasive, relatively safer, and simpler procedure.