Ultrasonic Elastography Guided Transthoracic Pleural Biopsy: A Prospective Pilot Study

Background: The diagnostic yields of traditional ultrasound guided pleural biopsy (TU-PB) is still unsatisfying, especially when the pleura thickness is ≤5mm or no pleural nodule is detected. Pleural ultrasound elastography (UE) was proven to have a better diagnostic yield than that of TU for malignant pleural effusion (MPE). Aims and objective: This study was designed to assess the diagnostic performance and safety of UE guided pleural biopsy (UE-PB) for diagnosing MPE. Methods: We prospectively enrolled patients with pleura thickness ≤ 3mm or no pleural nodule was detected into UE-PB group (Figure1). The patients who underwent flexible thoracoscopy (FT) were enrolled into FT group. The cases of TU-PB derived from the previous published prospective studies were summarized and set as TU-PB group. The diagnostic efficacy of UE-PB for MPE was compared with the other two groups. Results: A total of 34 patients and 38 patients were enrolled into UE-TB group and FT group, respectively. We derived 680 cases of TU-PB from 6 published studies. The diagnostic yield of UE-PB was 91.2% (31/34) which was superior to that of TU-PB (72.8%, 495/680) (p=0.018). The sensitivity of UE-PB (91.3%, 21/23) for MPE was superior to that of TU-PB (69.9%, 160/229) (p=0.029). There was no difference in diagnostic yield between UE-PB group and FT group (94.7%, 36/38). Conclusion: UE-PB is a novel technique for diagnosing MPE with a better diagnostic yield than that of TU-PB, similar to that of FT.