From the author:
I thank K. Psathakis and V. Skouras for their detailed comments. Although it has been demonstrated that the additional diagnostic yield of blind-pleural biopsy in the diagnosis of malignant pleural effusion to thoracocenthesis is limited to 7%, some pulmonary physicians persist in using this technique, also in countries with low prevalence of tuberculosis.
In my article, I stated that “Closed pleural biopsy should no longer be used in a setting where image-guided pleural biopsies can be obtained.” In my opinion, this statement is true for modern medicine in general. An image-guided technique, if available, is preferred over a blind procedure to obtain tissue for a histological diagnosis.
If in a situation that is getting rare in Europe and throughout the western world, thoracoscopy or image-guided biopsy facilities (computed tomography or ultrasound) are not available, closed pleural biopsy may be performed to obtain a diagnosis. Because of the poor results of this technique, and the general availability of three better options, closed pleural biopsy has been eliminated from the training programme of chest physicians in my hospital.
Footnotes
Statement of Interest
None declared.
Provenance
Submitted article, peer reviewed.
- ©ERS 2011
