Comparison of mycobacterial culture yield from pleural tissue using pleuroscopic cryobiopsy versus forceps biopsy in patients with tuberculous pleurisy.

INTRODUCTION: The diagnostic yield of mycobacterial culture from pleural tissue in tuberculous pleurisy is high and practical. However, the yield rates of mycobacterial culture from pleural tissue obtained through different pleural biopsy techniques via medical pleuroscopy remain unclear. This study aimed to compare the efficiency of mycobacterial culture from pleural tissue obtained by cryobiopsy and forceps biopsy during medical pleuroscopy for diagnosing tuberculous pleurisy.

METHODS: This retrospective study included 84 patients with tuberculous pleurisy who underwent mycobacterial culture testing using pleural tissue samples. Of these, 33 patients underwent pleuroscopic cryobiopsy and 51 underwent pleuroscopic forceps biopsy from April 2016 to December 2023 at two tertiary hospitals. Mycobacterial cultures from pleural tissue obtained by cryobiopsy and forceps biopsy were analyzed.

RESULTS: The average age of the participants was 67.1 years, with 67.9% being men. The sensitivity of Mycobacterium tuberculosis (MTB) cultures from pleural tissue was 54.5% (18/33) for cryobiopsy and 62.7% (32/51) for forceps biopsy (P = 0.455). The sensitivity of MTB culture was higher, up to 64.4% and 74.2%, in cases with pleural adhesion lesions and a combination of adhesion lesions and micronodules, respectively.

CONCLUSION: There was no significant difference in the yield rate of MTB culture obtained by cryobiopsy or forceps biopsy in cases of undiagnosed pleural effusion during pleuroscopy. When tuberculous pleurisy is suspected, forceps biopsy may be the optimal method for obtaining mycobacterial cultures from pleural tissue.