ArticleRespiratory research2025
Impact of pleural thickness on the sensitivity of computed tomography scan-guided cutting-needle pleural biopsy in diagnosing unexplained exudative pleural effusion.
Article in Respiratory research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers, 1 of them a synthesis that pooled it.
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2 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Diagnostic performance and safety of image-guided pleural biopsy and medical thoracoscopy for undiagnosed exudative pleural effusion: a systematic review and network meta-analysis.European respiratory review : an official journal of the European Respiratory Society · 2026Pooled it
- Diagnostic sensitivity and safety of visceral pleural biopsy under semi-rigid medical thoracoscopy in patients with undiagnosed exudative pleural effusions: a retrospective study.Therapeutic advances in respiratory diseaseObservational
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Abstract
backgroundIn most cases, patients with pleural effusion require a pleural biopsy to confirm the diagnosis, due to the low diagnostic sensitivity of thoracentesis. Among the different biopsy modalities, real time computed tomography scan-guided cutting-needle pleural biopsy (CT-CNPB) ensures high sensitivity and accessibility. However, there is no study investigating the difference in the diagnostic sensitivity of CT-CNPB for lesions with variable pleural thickness in effusions of different types.
methodsOf the 303 patients who underwent CT-CNPB, 218 met the eligibility criteria and were retrospectively analyzed from November 2021 to June 2024. Patients were divided into malignant pleural effusion (MPE), tuberculosis pleural effusion (TPE), and non-tuberculous benign pleural effusion (BPE) groups according to the diagnosis with a minimum follow-up of 6 months. Pleural thickness was defined as the length of the portion of the puncture needle that passes through the thickened parietal pleura or the pleural lesion (nodule/mass). In further analysis, we compare the differences in sensitivity between subgroups with different pleural thicknesses in each group.
resultsThe overall diagnostic sensitivity is 74.3%. The sensitivity in MPE, TPE, and BPE is 75.7%, 78.6%, and 67.8%, respectively. There was a significant difference in sensitivity between the < 5 mm and ≥ 5 mm groups in MPE and BPE groups but was not observed in the TPE group. In the further analysis, there was a significant difference in sensitivity between < 3 mm and 3-5 mm groups in TPE (p = 0.046) and a significant difference in sensitivity between 3 and 5 mm and 5-10 mm groups in MPE (p = 0.017), but a significant difference was not observed in BPE group.
conclusionCT-CNPB may serve as a preferred diagnostic approach in suspected TPE with pleural thickening ≥ 3 mm and suspected MPE with thickening ≥ 5 mm on chest CT. Where MT is unavailable, CT-CNPB is a viable alternative for suspected MPE or TPE patients with pleural thickening, nodularity, or mass lesions observed on CT. However, in suspected BPE, CT-CNPB alone is often insufficient; integrated clinical, laboratory, and imaging evaluation remains essential.
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