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Introduction Materials and Methods Results Conclusion The risk of malignancy (ROM) remains an area of interest for further evaluation in reporting systems including in International System for reporting serous fluid cytopathology (TIS), which is a standardized system for reporting effusion cytology. Herein, we report our findings in further investigation of ROM in TIS by studying on paired pleural effusion specimens and corresponding pleural biopsies with emphasis on negative for malignancy, and atypia of undetermined significance categories.The  Johns Hopkins Hospital pathology database was retrospectively searched for patients with a pleural biopsy (PBX) and a paired pleural effusion (PF) cytology specimens over a 4‐year period. We employed the TIS categories. The following statistical parameters were evaluated: sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and ROM.A total of 223 patient cases were included. Effusions TIS reclassification and ROM were as follows: 1.8% non‐diagnostic (ROM 75%), 75.8% negative for malignancy (ROM 23%), 4.9% atypical cells of undetermined significance (ROM 45%), 2.2% suspicious for malignancy (ROM 80%), and 15.2% malignant (ROM 100%). Overall accuracy, sensitivity, specificity, PPV and NPV were calculated and were 79.4%, 45%, 97.7%, 91.2% and 77%, respectively. Among, discordant cases diagnosed negative for malignancy on PF and positive for malignancy on PBX, there were significant number of lymphomas, mesotheliomas, and sarcomas. Lung cancer was the most common carcinoma; however, rare types of carcinomas were noted. Cells blocks and immunohistochemistry (IHC) studies were utilized to confirm either malignant conditions or rule out malignancy in both cell blocks and histology biopsies.This study demonstrates the high specificity and ROM for ‘malignant’ and ‘suspicious for malignancy’ categories in the TIS reporting system and highlights the modest negative predictive value for the ‘negative for malignancy’ category. Although Tissue biopsies are usually considered as ‘gold standard’, any definitive diagnosis of malignancy of body fluid should be considered positive for malignancy in further clinical decision‐making. [ABSTRACT FROM AUTHOR]

Here we report a rare case of immunoglobulin G4 (IgG4)–related pleural disease diagnosed using a thoracoscopic pleural biopsy. A 66‐year‐old man was admitted to our hospital with right‐dominant bilateral pleural effusions and gradually worsening dyspnoea. Chest radiographs revealed right‐dominant pleural effusions, while chest computed tomography showed bilateral pleural effusions without parenchymal lesions. Although the bilateral pleural effusions were exudative with an increased number of lymphocytes, the definitive diagnosis was initially elusive. High IgG4 levels in the serum and pleural effusions were observed. A pathological evaluation of a right pleural biopsy specimen collected via video‐assisted thoracoscopic surgery showed fibrosis‐associated lymphoplasmacytic infiltration, 45–60 IgG4‐positive plasma cells per high‐power field, and an IgG4/immunoglobulin G ratio of 40%. Consequently, the patient was diagnosed with IgG4‐related pleural disease. The bilateral pleural effusions improved after corticosteroid therapy. [ABSTRACT FROM AUTHOR]

No abstract available. Article truncated after 150 words. Clinical History: A 65-year-old woman with presents with intermittent right-sided chest pain and shortness of breath / dyspnea on exertion for several months’ duration. The patient’s past medical history includes a history of myocardial infarction with stent placement and atrial fibrillation. She has no prior surgical history aside from carpal tunnel release and tonsillectomy. The patient is a lifelong non-smoker, she reports no allergies and she drinks alcohol only socially and denies illicit drug use. Her medications include Xarelto (rivaroxaban) for her atrial fibrillation, alendronate, atorvastatin, metoprolol, and pantoprazole in addition to a multivitamin. On physical examination the patient was obese but not in acute distress, with normal blood pressure, pulse rate, and respiratory rate. Her pulmonary and cardiovascular examination was unremarkable aside for dullness to percussion over the right posterior and lateral thorax, and her musculoskeletal examination did not disclose any abnormalities. She was neurologically intact. Oxygen saturation at …

Pleural effusion is a common problem in our country, and most of these patients need invasive tests as they can’t be evaluated by blood tests alone. The simplest of them is diagnostic pleural aspiration, and diagnostic techniques such as medical thoracoscopy are being performed more frequently than ever before. However, most physicians in India treat pleural effusion empirically, leading to delays in diagnosis, misdiagnosis and complications from wrong treatments. This situation must change, and the adoption of evidence-based protocols is urgently needed. Furthermore, the spectrum of pleural disease in India is different from that in the West, and yet Western guidelines and algorithms are used by Indian physicians. Therefore, India-specific consensus guidelines are needed. To fulfil this need, the Indian Chest Society and the National College of Chest Physicians; the premier societies for pulmonary physicians came together to create this National guideline. This document aims to provide evidence based recommendations on basic principles, initial assessment, diagnostic modalities and management of pleural effusions.

Pleural effusion is a common problem in our country, and most of these patients need invasive tests as they can't be evaluated by blood tests alone. The simplest of them is diagnostic pleural aspiration, and diagnostic techniques such as medical thoracoscopy are being performed more frequently than ever before. However, most physicians in India treat pleural effusion empirically, leading to delays in diagnosis, misdiagnosis and complications from wrong treatments. This situation must change, and the adoption of evidence-based protocols is urgently needed. Furthermore, the spectrum of pleural disease in India is different from that in the West, and yet Western guidelines and algorithms are used by Indian physicians. Therefore, India-specific consensus guidelines are needed. To fulfil this need, the Indian Chest Society and the National College of Chest Physicians; the premier societies for pulmonary physicians came together to create this National guideline. This document aims to provide evidence based recommendations on basic principles, initial assessment, diagnostic modalities and management of pleural effusions. [ABSTRACT FROM AUTHOR]

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Abstract Here we report a rare case of immunoglobulin G4 (IgG4)–related pleural disease diagnosed using a thoracoscopic pleural biopsy. A 66‐year‐old man was admitted to our hospital with right‐dominant bilateral pleural effusions and gradually worsening dyspnoea. Chest radiographs revealed right‐dominant pleural effusions, while chest computed tomography showed bilateral pleural effusions without parenchymal lesions. Although the bilateral pleural effusions were exudative with an increased number of lymphocytes, the definitive diagnosis was initially elusive. High IgG4 levels in the serum and pleural effusions were observed. A pathological evaluation of a right pleural biopsy specimen collected via video‐assisted thoracoscopic surgery showed fibrosis‐associated lymphoplasmacytic infiltration, 45–60 IgG4‐positive plasma cells per high‐power field, and an IgG4/immunoglobulin G ratio of 40%. Consequently, the patient was diagnosed with IgG4‐related pleural disease. The bilateral pleural effusions improved after corticosteroid therapy.

Background: Pleural diseases involve the parietal and visceral pleura. They can be of inflammatory or malignant origin. Pleural biopsy is advised for assessment and excluding infectious causes as tuberculosis or malignant disease, particularly malignant mesothelioma. Connective tissue disorders such as rheumatoid disease can also present with involvement of pleura, requiring pleural biopsy for diagnosis. Objectives: The aim of my study was to find out diagnostic outcomes of open pleural biopsy or differentiation between benign (noncancerous) and malignant (cancerous) disease, to diagnose viral, fungal and parasitic diseases of pleura. Materials and Methods: Non-random sampling was used for data collection from Gulab Devi hospital. To find out the clinical value of nonspecific pleural biopsy specimen and fluid malignant neoplasm and tuberculosis. Data was collected from the patients undergoing procedure at Gulab Devi hospital. The collected data consists of 160 patients included females and males of all age groups. Results: 160 patients were undergone biopsies. Out of 160 patients a nonspecific or normal result was found in 53(33.3%). Diagnostic of malignant neoplasm in 18(10.9%) and granulomatous disease in 28(17%). Tuberculosis was found in 46 (28.9%). Histopathologically, pnemonitis was found in 16 (10.1%). Conclusion: Open pleural biopsy is precise and gold standard investigative method for malignancy. Pleural biopsy is safe easily performed and useful in diagnoses of tuberculosis or malignancy.

Background: Patients with tuberculous empyema (TE) can have a serious impact on lung function as their disease progresses, and, if left untreated, can cause damage to other parts of the body such as the thorax and spine, causing pain and inconvenience to the patient. Early diagnosis and the search for appropriate treatment are key to improving the survival rate of the disease. Methods: We report a case of a young patient with an unexpected finding of right pleural effusion on physical examination, who was eventually diagnosed with TE using next-generation sequencing of pleural tissue. We analyzed the literature to improve clinicians' understanding of TE and how to properly diagnose and treat the disease. Results: Laboratory results of the pleural effusion suggested a possible Mycobacterium tuberculosis infection, but pathogen-related tests were negative, and the diagnosis was eventually successfully confirmed by thoracoscopic pleural biopsy. Conclusions: The diagnosis of TE should be considered in young patients with pleural thickening of the empyema. Adenosine deaminase may provide diagnostic direction in patients with unexplained thorax abscess. Pleural biopsy, although an invasive procedure, is an essential diagnostic tool in some cases. [ABSTRACT FROM AUTHOR]

Background & Method: The aim of present study is to compare Gene Xpert findings in suspected tubercular pleural effusion cases with AFB smear, MGIT Culture and Histopathology in pleural biopsy. A sample which is found to be positive by any of three tests (smear microscopy, histopathology, MGIT culture) were considered as final positive as well as considered as composite reference standard (gold standard) and was compared with Gene Xpert. Result: Gene Xpert assay in Pleural biopsy was found positive in 26% cases; among these, four cases were rifampicin resistant. MGIT Culture was positive in 43% cases and histopathology was positive for 61% cases. While smear microscopy was positive in only 8% cases. Conclusion: Gene Xpert of pleural biopsy sample is a better diagnostic modality as compared to the direct smear examination for diagnosis of tubercular pleural effusion. But MGIT culture & histopathology of pleural biopsy sample are better diagnostic modality as compared to the Gene Xpert assay for diagnosis of tubercular pleural effusion. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to report an isolated pleural cryptococcosis with pleural effusion as the only manifestation, confirmed by pleural biopsy in a patient with thymoma combined with myasthenia gravis, who developed pleural effusion of unknown origin after long-term glucocorticoids and tacrolimus therapy. Methods: Pathological examination of the right pleural biopsy tissue from a patient with unexplained recurrent pleural effusion was implemented. Morphological analysis of the fungal component and metagenomic nextgeneration sequencing (mNGS) on the pleural tissue were performed. Results: A biopsy specimen of the right pleura revealed numerous yeast-like organisms surrounded by mucous capsules and Cryptococcus neoformans was detected by mNGS with a species-specific read number (SSRN) of 4, confirming the diagnosis of pleural cryptococcosis. Pleural effusion was eliminated with amphotericin B and fluconazole, and healthy status was maintained at the time of review 1 year later. Conclusion: Cryptococcosis, manifested by simple pleural effusion, is extremely rare, but when repeated pleural effusion occurs in immunocompromised patients or in patients with malignant tumors, the possibility of cryptococcosis should be treated with high vigilance and pleural biopsy is recommended if necessary in order to confirm the diagnosis. [ABSTRACT FROM AUTHOR]

Context Exudative pleural effusion is a diagnostic dilemma that includes many steps; one of them is obtaining a definite diagnosis through pleural biopsy. Cryoprobes are being increasingly used for obtaining larger specimens with fewer crush artifacts. However, the safety and feasibility of cryoprobe biopsy compared with standard forceps for pleural biopsy have not been fully assessed. Aims To evaluate the diagnostic value, size, and quality of the specimens obtained by flexible cryoprobe in comparison with those obtained by flexible forceps probe during medical thoracoscopy in patients with exudative pleural effusion and to assess the possible complications from the procedure. Settings and design This interventional prospective study was carried out at the endoscopy unit at Chest Department and Tuberculosis Assiut University Hospital. Patients and methods This study included 60 patients with undiagnosed exudative pleural effusion. Medical thoracoscopy was carried out for all the patients, and pleural biopsies were taken from the parietal pleura using a conventional rigid forceps probe and flexible cryoprobe in the same settings. Results Cryoprobe biopsy established a definite diagnosis in 55/60, with 91.6% diagnostic yield, whereas forceps biopsy had a definite diagnosis in 53/60, with 88.3% diagnostic yield. The size of cryoprobe biopsy was significantly larger in comparison with the forceps biopsy (26.56 ± 22.16 vs. 17.38 ± 12.08 mm2; P<0.001). The depth of pleural biopsy was evaluated by the presence of extrapleural fat cells, which were significantly higher in cryoprobe biopsy in comparison with forceps biopsy [21 (35%) vs. 11 (18.3%); P=0.03]. There were no significant complications or procedure-related deaths. Conclusions Cryobiopsy is a possible safe and effective alternative to conventional forceps probe biopsy in the diagnosis of exudative pleural effusion with a larger, deeper, and less number of biopsies. It was also found that cryoprobe biopsy had a better diagnostic yield, sensitivity, and accuracy. [ABSTRACT FROM AUTHOR]

Key message Pleural amyloidosis does not present with specific imaging findings and is difficult to diagnose unless pleural biopsy is performed. However, distinguishing pleural amyloidosis from malignant disease is important and biopsy should be performed wherever possible to establish a treatment plan as early as possible.

Key message: Pleural amyloidosis does not present with specific imaging findings and is difficult to diagnose unless pleural biopsy is performed. However, distinguishing pleural amyloidosis from malignant disease is important and biopsy should be performed wherever possible to establish a treatment plan as early as possible. [ABSTRACT FROM AUTHOR]

Background: Pleural diseases commonly encountered are pleural effusion, pneumothorax, pleural wall thickening, and pleural mass. Medical thoracoscopy is a minimally invasive procedure that allows diagnostic and therapeutic intervention. The medical diagnostic thoracoscopy in local anesthesia is a simple, low-cost investigation with relatively high diagnostic accuracy, no mortality, and low morbidity. A diagnosis of pleural tuberculosis (TB) could be achieved in 99% of patients as against 51% using closed pleural biopsy. Aims and Objectives: Assessment of the role of medical rigid thoracoscopy in patients with pleural effusion of unknown etiology in a tertiary health care setup. The primary objectives of the study were to evaluate the diagnostic yield of medical thoracoscopy in pleural effusion of unknown etiology. Materials and Methods: The study duration/time frame to address the study: November 2017–February 2019 sample size with Justification Sample size: Minimum 31 patients. It was a prospective observational study. All patients admitted in hospital/daycare at LHRC presenting with pleural effusion with unknown etiology. All patients had a medical thoracoscopy, and samples were sent for microbiological and histological analysis. Clinical, thoracoscopic results and histopathological data of the patients were collected prospectively and analyzed. Results: In this study, 28 patients out of 31 patients were diagnosed. The diagnostic yield of thoracoscopic pleural biopsy was 90.3% Out of 31 patients, the most common complication found was chest pain 48.4% (15/31), followed by 09.7% (03/31) of the cases had complications such as surgical emphysema, postoperative fever, and bleeding. There were no complications in 32.2% (10/31) patients. Conclusion: Medical thoracoscopy is a noble procedure that helps the pulmonologist/surgeon to inspect the pleural cavity. It is a safe and effective diagnostic as well as a therapeutic tool with a high diagnostic yield. The most common differentials of undiagnosed pleural effusion cases are TB and malignancy.

Background: Thoracoscopy is a minimally invasive procedure that allows visualization of the pleural space and intrathoracic structures. In tuberculous pleuritis, the combined yield of histology and culture for rigid thoracoscopy was nearly 100%. The aim of the present study was to examine the diagnostic yield of medical thoracoscopy in patients with undiagnosed exudative pleural effusion. Patients and methods: This study was carried out at the Department of pulmonary medicine, SVRRGGH, TIRUPATI in the period from June 2022 to June 2023. It included 50 patients with undiagnosed pleural effusion. The included patients were subjected to full history taking, clinical examination, plain chest radiograph, ultrasonography, computed tomography of the chest, and tuberculosis assessment. Diagnostic aspiration of pleural fluid was performed by using chemical, cytological, and bacteriological analyses. Lastly, if the etiology remained unknown, a thoracoscopy was carried out. Results: The present study included 25 men and 25 women patients, with a mean age of 54.4±16.1 years. Dyspnea was the most common presenting symptom among the studied patients. 36 (72.2%) patients had moderate right-sided pleural effusion. The diagnostic yield of medical thoracoscopy among the studied patients was 80.6%. The histopathological yield of thoracoscopic pleural biopsies was as follows: 40 (80%) malignant cases, (20%) patients with tuberculous pleuritis. The post-thoracoscopic complications in this study occurred only in nine (25%) patients, which were minor complications in the form of surgical emphysema and prolonged air leak, wound infection, dislodged drain, trapped lung, and pain during the procedure. Conclusion: Medical thoracoscopy is a good diagnostic procedure for pulmonologists to evaluate undiagnosed pleural effusions. [ABSTRACT FROM AUTHOR]

Background: Pleural biopsies offer greater diagnostic sensitivity in malignant pleural effusions (MPE) compared to pleural fluid. The adequacy of pleural biopsies to achieve molecular marker status has not been studied and such information (termed 'actionable' histology) is critical in providing a rational, efficient and evidence-based approach to diagnostic investigation.Research Question: What is the adequacy of various pleural biopsy techniques at providing adequate molecular diagnostic information to guide treatment in MPE?Study Design and Methods: We analysed anonymised data on 183 patients from 4 sites across 3 countries in whom a pleural biopsy had confirmed a malignant diagnosis and molecular profiling was relevant for the diagnosed cancer type. The primary outcome measure was adequacy of pleural biopsy for achieving molecular marker status. Secondary outcomes included clinical factors predictive of achieving a molecular diagnosis.Results: The median age of patients was 71 (IQR 63-78), with 92/183 (50%) male. Of the 183 procedures, 105 (57%) were Local anaesthetic thoracoscopies (LAT), 12 (7%) were Computed tomography (CT) guided and 66 (36%) were Ultrasound (US) guided. Successful molecular marker analysis was associated with mode of biopsy, with LAT having the highest yield and US-guided biopsy the lowest (LAT vs CT-guided vs US-guided (LAT yield 95%, CT-guided 86%, US guided 77%, p = 0.004). Biopsy technique and size of biopsy were independently associated with successful molecular marker analysis. LAT had an adjusted OR for successful diagnosis of 30.16 (95% CI 3.15-288.56, p = 0.003) and biopsy size an OR of 1.18 (95% CI 1.02-1.37) per mm increase in tissue sample size (p <0.03).Interpretation: Although previous studies have shown comparable overall diagnostic yields, in the modern era of targeted therapies, this study shows that LAT offers far superior results to image guided techniques at achieving molecular profiling and remains the optimal diagnostic tool. [ABSTRACT FROM AUTHOR]

Background: The most typical pleural pathology manifestation is still pleural effusion. Despite routine biochemical and cytological examination of the pleural fluid, it can sometimes be challenging to distinguish between tubercular and malignant pleural effusion. Aims- This study aims to assess the value of pleural biopsy in identifying the cause of pleural effusion and correlating it with cytological and biochemical pleural fluid parameters. Methods: thirty consecutive patients of pleural effusion were selected from the out patient and indoor department of a tertiary hospital of central India. Biochemical, cytological and microbiological evaluation of pleural fluid was done in all cases. Those with exudative pleural effusions underwent pleural biopsy. Subsequently, the etiology of effusion was determined. Results: Malignancy was the most common etiology, followed by tuberculosis. Pleural biopsy was done in 30 patients. Malignancy was diagnosed in 13, tuberculosis in 10 and 7 cases were remain undiagnosed, on histopathological examination. Mean value of pleural fluid ADA in malignancy patients is 11.5, whereas in tuberculosis patients its 28.6. Conclusions: In our study, malignancy is more common than tuberculosis. pleural fluid cytology and pleural biopsy can give definite diagnosis. [ABSTRACT FROM AUTHOR]

Image-guided lung biopsy plays a very important role in the diagnosis and management of lung lesions. As a diagnostic tool, it demands a high diagnostic yield and a low complication rate. It is imperative to balance the diagnostic yield and patient safety during lung biopsies. The aim of this article is to review the standard practice guidelines of lung biopsy, to describe the techniques used to minimize the complications associated with lung biopsy, and to describe the management of complications.

Background: The most objective of assessment in patients with undiagnosed pleural effusion is to set up early diagnosis and encourage treatment with minimal invasive procedure. Video-assisted thoracoscopic surgery (VATS) is regularly considered as gold standard examination for an undiagnosed pleural effusion with great diagnostic value. Objectives: This study was arranged to assess the role of (VATS) in the diagnosis of unexplained exudative pleural effusion. Patients and Methods: This is a retrospective study included all patients who underwent VATS for undiagnosed exudative pleural effusion patients from 2014 to 2020. Results: Total 105 patients who underwent VATS for undiagnosed pleural effusion in this time period as the diagnostic as well as therapeutic methods were included in the study. The overall mean age was 46.5± 20.71 and we had 51 Males (48.57%) and 54 Females (51.43%).There were 48 patients (54.29%) with co-morbidities most of them had diabetes mellitus (DM) in 36 patients (34.29%). The most common radiological findings were right free pleural effusion in 45 patients (42.86%) and pleural thickness in 42 patients (40%).VATS pleural drainage and biopsy (right and left) most common performed procedure in 75 patients (71.43%).Final histopathological diagnosis was nonspecific inflammation in 15 patients (14.29%), pleural TB in 57 patients(54.29%) and malignancy in 33patients (31.43%). Conclusion: VATS is a good diagnostic and therapeutic method. Therefore, patients had undiagnosed exudative pleural effusions should be underwent V

Purpose: To assess the efficacy and safety of a low-dose, computed tomography (CT)-guided transthoracic biopsy of lung and pleural lesions. Material and methods: A total of 135 low-dose, CT-guided transthoracic lung and pleural lesions biopsies were performed. A cutting needle was utilized in 124 cases, and fine needle aspiration biopsy was performed in 14 cases. In all cases, 14- to 22-gauge biopsy needles were used. Results: Diagnostic material was obtained in 111 (82.2%) patients. In 97 (71.8%) cases neoplastic lesions were found, predominantly adenocarcinoma and non-small cell carcinoma. In 14 (12.6%) cases non atypical cells were reported. Biopsy failed to obtain material suitable for histopathological examination in 24 (17.7%) cases. Complications occurred in 31 patients, including pneumothorax in 28 patients and haematoma in 3 cases. Conclusions: Based on the obtained results, it can be stated that low-dose, CT-guided transthoracic biopsy of lung and pleural tissues is an accurate and safe procedure. Also, it is linked to a low risk of complications such as a small pneumothorax. [ABSTRACT FROM AUTHOR]

A pleural exudate that remains undiagnosed after a combined clinical assessment, thoracentesis, and imaging requires a pleural biopsy for a definitive diagnosis. Thoracoscopy is often the first method of choice to obtain tissue as it offers greater sensitivity and there is a perception of less risk. However, with imaging guidance, closed pleural biopsy is a safe, affordable, and effective alternative to diagnose all forms of pleural disease. Ultrasound (US) has several benefits when compared with computed tomography for image-guided biopsy, as it is widely available, can be performed bedside, and does not expose the patient to radiation. If performed in optimal conditions, a transthoracic USguided closed pleural biopsy can yield results comparable to those of thoracoscopy and a marked reduction in the complication rate versus blind biopsy. Abrams and Tru-Cut needles are the most widely used for a closed pleural biopsy. Either may be used with real-time image guidance or with a free-hand image-assisted technique to harvest up to 6 separate tissue samples. The needle choice will depend on the morphology of the lesion observed on imaging. The Tru-Cut is generally preferred for mass lesions of the pleura or pleura that is >20 mm in thickness, and the Abrams for pleural thickening of <20 mm or radiologically normal pleura. A transthoracic US may be used to detect, rule out, and prevent complications, such as bleeding, solid organ injury, or pneumothorax. The ability to perform thoracic US is a necessary skill in current respiratory practice, and US-guided closed pleural biopsy has a critical role in diagnosis. [ABSTRACT FROM AUTHOR]

The incidence of distant metastasis in head and neck Squamous Cell Carcinoma (SCC) is relatively low. The most frequently involved sites for distant metastasis are lungs, followed by bone and liver. The most important predictive factors for distant metastasis appear to be site of the primary tumour (hypopharynx), advanced T- and N-classification, locoregional control and histologic grade. A 61-year-old male, chronic smoker, presented with complaints of grade 4 mMRC (Modified Medical Research Council) dyspnoea. He had left-sided buccal mucosal SCC (locally advanced) and was on palliative chemotherapy. He had undergone treatment for pulmonary tuberculosis seven years back. He was tachypneic and clinical examination revealed absent breath sounds in the left hemithorax. Chest radiograph showed a massive left pleural effusion which was found to be exudative after therapeutic thoracocentesis. Cytology tests were negative for malignant cells. Positron Emission Tomography (PET) scan showed uptake along the left pleura (SUV Max-5.06) and left buccal mucosa (SUV Max -4.1). Thoracoscopic frozen section pleural biopsy revealed metastatic squamous cell carcinomatous deposits in the pleura. On table pleurodesis was done with doxycycline. The patient was continued on palliation with no recurrent effusion. However, he succumbed to the disease after eight months. This case report describes a rare case of malignant pleural effusion from a primary buccal mucosal SCC without any concurrent lung involvement.

We report a case of a 65-year-old man with a cavitary lung mass and parietal-based pleural nodules in which a pleural ultrasound-guided approach yielded a definitive diagnosis of stage IV non-small cell lung carcinoma. Computed tomography-guided biopsy is often preferred approach for the majority of United States hospitals for sampling pleural nodules as compared to US. The advantages of an US-guided approach include [1]: increased portability [2]; decreased procedure time [3]; reduced reliance on dedicated ancillary support staff [4]; need for local anesthesia only [5]; lack of ionizing radiation exposure; and [6] cost reduction.

Image-guided lung biopsy plays a very important role in the diagnosis and management of lung lesions. As a diagnostic tool, it demands a high diagnostic yield and a low complication rate. It is imperative to balance the diagnostic yield and patient safety during lung biopsies. The aim of this article is to review the standard practice guidelines of lung biopsy, to describe the techniques used to minimize the complications associated with lung biopsy, and to describe the management of complications. [ABSTRACT FROM AUTHOR]

Earlier diagnosis of lung cancer improves outcomes for two main reasons. First, the disease stage may be earlier allowing more chance of curative-intent treatment. Second, patients may be fitter at presentation. Functional status is one of the most important independent predictors of survival. Although lung cancer is caused by smoking in 80-85% of cases, around 6,000 patients per year do not have smoking-attributable lung cancer and 3,500 patients have never smoked. These patients are often diagnosed late, so it is important to refer patients who have persistent symptoms either for chest X-ray, or when symptoms persist and no alternative diagnosis is found, refer for consideration of CT. NHS England has started a phased implementation of screening with low radiation dose CT in areas with a high incidence and mortality from lung cancer, the Targeted Lung Health Check programme. More than 1,200 cancers have been detected and 76% are stage I/II. For those with early stage disease, unwilling or unable to undergo surgery, curative-intent radiotherapy such as stereotactic ablative body radiotherapy is widely available. Advances in stereotactic radiosurgery mean many patients with brain metastases can still be treated with curative intent. Smoking cessation advice and therapy should be integral to the management of lung cancer, whether suspected or confirmed and when screening. Smoking cessation improves outcomes for all stages of lung cancer. [ABSTRACT FROM AUTHOR]

Background: Cytological smear and cell block are commonly used to diagnose pleural fluid effusion. However, there is a paucity of information in the literature where a comparison between a cytological smear and a cell block with corresponding pleural biopsy has been done. This study aimed to evaluate the accuracy of cytological smears, cell blocks, and pleural biopsy for the diagnosis of malignant tumors. Material and Methods: In this cross-sectional study, analysis of successive pleural fluid samples received by the department was done. The sample was divided into equal halves of 5 ml each. One was used for conventional smear and the second was used for the preparation of cell block. The cell block was prepared by centrifuging the specimen of fluid at 2500 rpm for 15 min. A pleural biopsy was obtained by using Cope's pleural biopsy needle. Results: A total of n = 50 cases were included in the study. A total of n = 8 cases were diagnosed as malignant by cell smear and n = 4 cases were suspicious for malignancy. By cell block, n = 10 cases of malignancy were diagnosed and n = 1 case was suspicious for malignancy. By biopsy, n = 11 cases were diagnosed as malignant and n = 1 case was suspicious for malignancy. Out of the total, n = 2 cases were diagnosed as squamous cell carcinoma by biopsy; one case was diagnosed by cell block; and the other was reported as suspicious for malignancy. Conclusion: The study shows that cell blocks are complementary to the cell smear technique in over diagnosis and categorization of benign as well as malignant cells. The cell blocks were more useful in the diagnosis of malignancy because of better preserved architectural patterns as seen in corresponding histopathology sections. It, therefore, appears that the cell blocks are a perfect fit to bridge the cytology and histopathology. [ABSTRACT FROM AUTHOR]

Malignant pleural effusions are common in patients with cancer. Most malignant pleural effusions are secondary to metastases to the pleura, most often from lung or breast cancer. The presence of malignant effusion indicates advanced disease and poor survival; in lung cancer, the presence of malignant effusion upstages the cancer to stage 4. Usually presenting as a large, unilateral exudative effusion, most patients with malignant pleural effusion experience dyspnea. Prior to intervention, diagnosis of malignant pleural effusion and exclusion of infection should be made. Thoracic imaging is typically performed, with computed tomography considered by many to be the gold standard. Thoracic ultrasound is also useful, particularly if diaphragmatic or pleural thickening and nodularity can be identified. Cytology should then be obtained; this is typically done via pleural fluid aspiration or pleural biopsy. Treatment focuses on palliation and relief of symptoms. Numerous interventions are available, ranging from drainage with thoracentesis or indwelling pleural catheter to more definitive, invasive options such as pleurodesis. There is no clear best approach, and a patient-centered approach should be taken. [ABSTRACT FROM AUTHOR]

Background: Cytological smear and cell block are commonly used to diagnose pleural fluid effusion. However, there is a paucity of information in the literature where a comparison between a cytological smear and a cell block with corresponding pleural biopsy has been done. This study aimed to evaluate the accuracy of cytological smears, cell blocks, and pleural biopsy for the diagnosis of malignant tumors. Material and Methods: In this cross-sectional study, analysis of successive pleural fluid samples received by the department was done. The sample was divided into equal halves of 5 ml each. One was used for conventional smear and the second was used for the preparation of cell block. The cell block was prepared by centrifuging the specimen of fluid at 2500 rpm for 15 min. A pleural biopsy was obtained by using Cope's pleural biopsy needle. Results: A total of n = 50 cases were included in the study. A total of n = 8 cases were diagnosed as malignant by cell smear and n = 4 cases were suspicious for malignancy. By cell block, n = 10 cases of malignancy were diagnosed and n = 1 case was suspicious for malignancy. By biopsy, n = 11 cases were diagnosed as malignant and n = 1 case was suspicious for malignancy. Out of the total, n = 2 cases were diagnosed as squamous cell carcinoma by biopsy; one case was diagnosed by cell block; and the other was reported as suspicious for malignancy. Conclusion: The study shows that cell blocks are complementary to the cell smear technique in over diagnosis and categorization of benign as well as malignant cells. The cell blocks were more useful in the diagnosis of malignancy because of better preserved architectural patterns as seen in corresponding histopathology sections. It, therefore, appears that the cell blocks are a perfect fit to bridge the cytology and histopathology.

Introduction: Exudative pleural effusion is one of the most commonly encountered clinical conditions for pulmonologists. Sometimes, etiological diagnosis of pleural effusion is difficult despite cytological, biochemical, and microbiological tests and is then labeled as undiagnosed exudative pleural effusion (UPE). The present study aimed to assess the diagnostic yield and safety of closed pleural biopsy (CPB) in such patients with UPE. Materials and Methods: This was a hospital-based, interventional study conducted on 101 UPE patients for 2 years. All patients were subjected to CPB using Abrams needle. Pleural biopsy samples were subjected to histopathology, Ziehl–Neelsen staining, and tuberculosis (TB) culture. All the data, including demographic characteristics, pleural biopsy reports, and procedure complications, were recorded. Statistical analysis was performed using the SPSS software 10 and results were expressed in terms of means and percentages. Results: A total of 101 patients (68 males and 33 females with a mean age of 50.1 years) were subjected to pleural biopsy. Of 88 patients in whom adequate pleural tissue was obtained, diagnosis of malignancy and TB was made in 36 and 31, respectively, and pleural biopsy examination findings were nonspecific (acute/chronic inflammation) in 21 patients. The diagnostic yield of pleural biopsy was 76%. Minor complications were observed in ten patients. Conclusions: A pleural biopsy is a valuable diagnostic tool in UPE cases. Malignancy was the most common cause of exudative pleural effusion, followed by TB in our setup. Pleural biopsy should be considered in all patients with UPE.

Background Ultrasound (US)-guided tru-cut pleural biopsy is a rapid technique that is cheap, has low complication, provides real-time visualization of the biopsy needle, and is without radiation. Aim To increase diagnostic yield of US-guided tru-cut pleural biopsy by taking biopsy from two different sites and to study factors increasing this yield for an effective, safe, and noninvasive substitute of thoracoscopy. Patients and methods Randomly chosen 80 patients with undiagnosed pleural effusion were scanned by US and classified into two groups: one-pore group where tru-cut US-guided pleural biopsy was done using one opening in the most safe, accessible, thick nodular pleura and the other group is the two-pore group, taking the biopsy from two different site, making two pores instead of one. Results The two groups were comparable to each other in diagnostic yield, with no significant difference, and the factors affecting this yield were the more thickness of pleura, presence of nodularity or masses, and the caliber of the cutting needle. Conclusion There is no need for more than one pore for taking US-guided tru-cut pleural biopsy, and diagnostic yield depends on more needle caliber and the thickness of the pleura.

Disseminated tuberculosis is a rare form of tuberculosis that can cause severe illness if diagnosed and treated late. We present the case of a young Senegalese woman who had a miscarriage due to a pelvic inflammatory disease, followed by the development of a left pleural effusion. Despite laparoscopic findings and a salpinx biopsy that revealed necrotizing granulomas, only microbiological examinations of pleural biopsies revealed the final diagnosis of disseminated, drug-sensitive tuberculosis.

Biopsies of the lung, pleura, and mediastinum play a crucial role in the workup of thoracic lesions. Percutaneous image-guided biopsy of thoracic lesions is a relatively safe and noninvasive way to obtain a pathologic diagnosis which is required to direct patient management. This article reviews how to safely perform image-guided biopsies of the lung, pleura, and mediastinum, from the preprocedural assessment to reviewing intraprocedural techniques, and how to avoid and manage complications. [ABSTRACT FROM AUTHOR]

Context Malignant mesothelioma is an insidious neoplasm, with malignant pleural mesothelioma as the most common type, which is characterized by poor prognosis in most patients owing to late presentation. The use of noninvasive markers for early diagnosis of malignant pleural mesothelioma is of great importance in decreasing the incidence of associated morbidity and mortality. Aims To evaluate the value of soluble mesothelin level in serum and pleural fluid as a diagnostic marker in patients with pleural malignancies and in differentiation of different causes of pleural effusion. Patients and methods We included 48 patients who were classified into three groups: group A (mesothelioma), group B (metastatic malignancy), and group C (transudative effusion). History taking, clinical examination, and laboratory assessment were performed in all groups, in addition to measuring mesothelin level in serum and pleural fluid. Histopathological examination of pleural biopsies was performed in groups A and B. Results Mesothelin levels in serum and pleural fluid demonstrated a statistically significant increase in group A as compared with the cases in groups B and C (P<0.001). Moreover, mesothelin levels in serum and pleural fluid demonstrated a statistically significant increase in the samples taken from the cases in group B as compared with the cases in group C (P<0.001). Conclusion Soluble mesothelin-related peptides (SMRP) could be used as a valuable marker in diagnosis of different causes of pleural effusion. The diagnostic accuracy of pleural fluid SMRP was higher as compared with the serum SMRP. [ABSTRACT FROM AUTHOR]

Introduction: Histological analysis of the pleura obtained by video-assisted thoracoscopic surgery (VATS) is the best diagnostic technique in the study of neoplastic pleural effusions. This study evaluates the relationship between Positron Emission Tomography (PET)/Computed Tomography (CT) and VATS findings, the result of the first pleural biopsy, and the final diagnosis of malignancy or non-malignancy., Methods: Prospective study of consecutive patients with pleural effusions undergoing PET/CT and VATS from October 2013 to December 2023. The following variables were recorded: PET/CT score (nodular pleural thickening, pleural nodules with standardized uptake value (SUV) > 7.5, lung mass or extra pleural malignancy, mammary lymph node with SUV > 4.5 and cardiomegaly); VATS data (drained volume, visceral and parietal pleural thickening, nodules or masses, septa, plaques, fluid appearance, trapped lung, and suspected diagnosis of the procedure), as well as the histological study of the first pleural biopsy (benign or malignant) and the final diagnosis of benign or malignant pleural effusion. A logistic regression study of the variables was performed., Results: 95.8% of the patients with PET/CT and pleuroscopy not suggestive of malignancy had non-malignant histological findings, while 93.2% of the patients with PET/CT and pleuroscopy suggestive of malignancy had malignant histological findings. PET/CT, pleuroscopy, and the result of the first pleural biopsy showed a significant association with the final diagnosis of pleural effusion., Conclusions: There is a strong association between PET/CT findings, VATS and pleural histology., (Copyright © 2024 Sociedad Española de Medicina Nuclear e Imagen Molecular. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction: The use of ultrasound in respiratory disease has evolved substantially over the past two decades. From a test done to confirm the safe site of pleural fluid drainage, thoracic ultrasound has become a point-of-care test that guides the management of patients on respiratory wards, in clinics and endoscopy., Areas Covered: This review overviews the process of ultrasound examination in the chest. It then delves into specific disease areas (pleural disease, lung disease, diaphragm disease, and invasive procedures) to highlight how thoracic ultrasound is being used to refine management. The review concludes with discussion on the training curricula and assessment tools for competency in thoracic ultrasound. Being a scoping review, literature searches were conducted on PubMed using relevant search terms., Expert Opinion: In addition to its current uses, there are many avenues where thoracic ultrasound will soon be beneficial. Recent studies show promising roles in areas such as patient-tailored guidance of pleurodesis and non-invasively predicting lung re-expansion after pleural fluid drainage. In addition, auxiliary tools such as contrast-enhanced ultrasound and elastography are proving useful in identifying the etiology and directing the successful sampling of pleural and lung lesions. Studies are also exploring the utility of sonographic biomarkers such as echogenicity and septations to predict outcomes in pleural disease.

Amebic lung abscess without involving another system like liver or colon is immensely uncommon. We want to report a case of a 72-year-old woman who presented in emergency with complaints of shortness of breath, loss of weight, right-side chest pain, and loss of appetite since 6 months. Thorax and abdomen sonography showed right-side massive pleural effusion with no significant finding in the abdomen. In pleural fluid reports, amebic serology IgG by indirect immunofluorescence assay and serum PCR for amoeba came positive. The patient was diagnosed with primary amebic lung abscess. After 14 days of treatment, the patient showed no signs of improvement. Pleural tap was done again and came positive for malignant cells. With ultrasound guidance, pleural biopsy was done, and histopathological investigations showed adenocarcinoma. This case exhibited that repetitive cytological examination of pleural effusion and histopathological examination should be used in cases showing recurrent effusion or unusual conditions, like our patient.

BackgroundMalignant pleural mesothelioma (MPM) is a highly invasive malignant tumor. Ultrasound guidance has the advantages of real-time, convenience and nonradiative. We sought to identify diagnostic value and its influenced factors of ultrasound-guided percutaneous pleural needle biopsy (US-PPNB) for MPM.MethodsPatients who underwent US-PPNB between March 2014 and March 2020 and were finally diagnosed with MPM were retrospectively analyzed. We retrospectively analyzed the US-PPNBs pathological results of all patients clinically confirmed as MPM, and divided US-PPNBs into correctly and incorrectly diagnosed groups. Patient, thoracic, and biopsy variables that affected diagnostic accuracy were assessed. All variables significant on univariate analyses were subjected to multivariate logistic regression to identify significant predictors of diagnostic accuracy. We derived cutoffs for all significant continuous variables and used the Mantel–Haenszel test to determine whether the diagnostic accuracy of US-PPNB for MPM increased with pleural thickness.ResultsIn total, 49 patients with clinically confirmed MPM underwent US-PPNB; 37 diagnoses were correct and 12 were incorrect (accuracy = 75.5%). The pleura was significantly thicker in the correctly diagnosed group (p

Background Adenosine deaminase (ADA) has been considered as a marker for cell-mediated immunity. The purpose of this study is to evaluate the usefulness of ADA as a biomarker in diagnosis of pleural effusion in tuberculosis (TB). Patients and methods Forty patients from Abbasia Chest Hospital who were suspected to have exudative pleural effusion and prepared for pleural biopsy were enrolled in the study. ADA in pleural fluid and serum was measured for all of them, and then data were reported and analyzed. Results Of the 40 patients included in the study, most of the 20 patients with TB pleurisy were diagnosed mainly by thoracoscope (16/20), whereas the rest four cases were diagnosed by sonar-guided biopsy. The other 20 patients, diagnosed as non-TB pleural effusion (6/20), mesothelioma (8/20), pneumonia, and adenocarcinoma (6/20). There were significant statistical difference between both groups regarding age, total leukocyte count, erythrocyte sedimentation rate, and tuberculin skin test, whereas no significant association regarding sex, clinical presentation, and radiological finding within any groups. ADA in effusion, serum, and index had a significant statistical difference between the two groups, with cutoff point value in effusion and serum of ~31.4 and 29.5 U/l, respectively, and 1.1 for the index, with sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of ~100, 90, 90, 100, and 95%, respectively, for ADA in effusion and serum, whereas for the index of ~80, 65, 69, 76, and 73%, respectively. Conclusion Serum and pleural fluid ADA level significantly increases in patients with TB pleural effusion than non-TB pleural effusion with higher sensitivity, specificity, positive predictive value, negative predictive value, and accuracy in prediction. [ABSTRACT FROM AUTHOR]

Objective: To determine the accurate ability to diagnose the pleural fluid GeneXpert MTB/RIF assessment in the suspected pleural tuberculosis patients considered as gold standard the pleural biopsy. Materials & Methods: This study was a validation cross-sectional survey and it was conducted in the pulmonology department of Pakistan Institute of Medical Sciences, Islamabad from 1st July to 31st December 2018 after approval of IRB. Participants with suspected pathology ≥ 18 years with exudative pleural effusion were included in the study. By implementing the process of the standard technique, closed needle pleural biopsy was executed by means of ABRAM'S needle. The collected samples of patients were sent to the pathology department of the Pakistan Institute of Medical Sciences for histopathology. Pleural fluid was referred to the National Institute of Health Islamabad for GeneXpert MTB/RIF assessment on the alike day and reports were assembled. All findings were entered in a structured Proforma. Data was entered in SPSS version 20 and analyzed. Results: A total of 180 patients were included; 65.6% of patients were male. When the sensitivity of pleural fluid GeneXpert MTB/RIF examination was calculated it was 10.4% whereas, the calculated specificity was 72.8%. While +ve predictive value of GeneXpert was 22.2% and the -ve predictive value was 52.1%. The likelihood ratio was 8.25 and the ROC curve also showed similar values. Conclusion: The sensitivity of pleural fluid GeneXpert MTB/RIF assay is very low and specificity is moderate for diagnosis of pleural tuberculosis when compared with pleural biopsy. [ABSTRACT FROM AUTHOR]

Background: Pleural effusion is an abnormal accumulation of fluid in the Pleural space. The pleural space lies between the lung and chest wall and normally contains a very thin layer of fluid, which serves as a coupling system. Excess fluid results from the disruption of the equilibrium that exists across pleural membranes. Material and Methods: This is a prospective and observational study condcuted on patients arriving at OPD/IPD services of SNMC/HSK with history and clinical features suggestive of pleural effusion between 2021 to 2022 with sample size estimated is 91 which is rounded off to100. All patients aged more than 18 years with clinical features and radiological evidence of pleural effusion. Results: Maximum number of patients of Pleural effusion is between 31-50 years of age. Most of the patients were male 69% and rest were female 31%. The mean value of pleural fluid glucose is 69.85 mg/dL and extremely low sugar was seen in patients with malignancy and pyogenic infections. In all the 18 transudative effusions, the pleural fluid protein/serum protein ratio was found to be < 0.5. In all the 82 exudative effusions, the pleural fluid protein/serum protein ratio was found to be > 0.5. Conclusion: While evaluating a case of pleural effusion, a combined approach, involving clinical evaluation, radiographic and sonographic evaluation, pleural fluid analysis, pleural fluid cytology, and in cases where possible thoracoscopic pleural biopsy, must be utilized to fruitful and accurate diagnosis. [ABSTRACT FROM AUTHOR]

The incidence of distant metastasis in head and neck Squamous Cell Carcinoma (SCC) is relatively low. The most frequently involved sites for distant metastasis are lungs, followed by bone and liver. The most important predictive factors for distant metastasis appear to be site of the primary tumour (hypopharynx), advanced T- and N-classification, locoregional control and histologic grade. A 61-year-old male, chronic smoker, presented with complaints of grade 4 mMRC (Modified Medical Research Council) dyspnoea. He had left-sided buccal mucosal SCC (locally advanced) and was on palliative chemotherapy. He had undergone treatment for pulmonary tuberculosis seven years back. He was tachypneic and clinical examination revealed absent breath sounds in the left hemithorax. Chest radiograph showed a massive left pleural effusion which was found to be exudative after therapeutic thoracocentesis. Cytology tests were negative for malignant cells. Positron Emission Tomography (PET) scan showed uptake along the left pleura (SUV Max-5.06) and left buccal mucosa (SUV Max -4.1). Thoracoscopic frozen section pleural biopsy revealed metastatic squamous cell carcinomatous deposits in the pleura. On table pleurodesis was done with doxycycline. The patient was continued on palliation with no recurrent effusion. However, he succumbed to the disease after eight months. This case report describes a rare case of malignant pleural effusion from a primary buccal mucosal SCC without any concurrent lung involvement. [ABSTRACT FROM AUTHOR]