Thoracoscopic pleural brushing- An addendum in diagnostic thoracoscopy

Introduction: Pleural biopsy is the commonest mode of obtaining thoracoscopic pleural specimens from suspected pleural lesions. However, this may be associated with risk of bleeding in certain cases. The decision to perform biopsy could be difficult especially when the lesions are close to vascular structures and visceral pleura. So pleural brushing can be used to get thoracoscopic specimens safely in addition to biopsy samples. Aims and Ojectives To determine the sensitivity and specificity of thoracoscopic pleural brushing in exudative pleural effusions. Methodology This prospective study was done in the Department of Pulmonary Medicine, Sri Manakula Vinayagar Medical College, Pondicherry, India on 52 patients with exudative pleural effusion in whom pleural fluid analysis and closed pleural biopsy results were inconclusive. All these patients were subjected to medical thoracoscopy after getting informed consent. Pleural biopsy and pleural brushings were taken and sent for analysis Results: Thoracoscopic pleural biopsy was diagnostic in 49 of 52 patients (94.2%). Thoracoscopic pleural brushing was diagnostic in 47 patients (90.4%). Histhopathology revelaed malignancy (82.7%), granulomatous inflammation(11.5%) and nonspecific inflammation(5.7%). The sensitivity and specificity of pleural brushing were 93.8% and 66.7% respectively. Interestingly, pleural brushing was the only diagnostic modalilty in one patient which was reported as adenocarcinoma. Conclusions Thoracoscopic pleural brushing is easy, convenient and safe procedure as it can augment the diagnostic yield of thoracoscopy. It is of significant value especially in sampling pleural lesions close to vessels and visceral pleura compared to pleural biopsy.