Pleural Nurse Specialist led Image Guided Pleural Biopsy Service – pleural tissue yield and change in diagnosis at 6 months follow up

To our knowledge, there are no Pleural Nurse specialists undertaking image-guided pleural biopsies. This is the first nurse-led, image-guided pleural biopsy in English literature. We aimed to examine the pleural tissue yield and any change in the patient’s management at 6 moth follow up after the biopsy. We retrospectively reviewed the first 40 image guided biopsies by the Pleural CNS from October 2022 to May 2023. The mean age was 69 (21 – 102). 30%(12/40) were females, and 70% (28/40) were males. 80% (32/40) had pleural tissue; 3 had insufficient samples; and 5 had only skeletal muscle. Out of the 32 pleural tissue samples, histology showed: 3 adenocarcinoma lung, 11 inflammatory pleuritis, 7 mesothelioma, 6 necrotising granulomatous inflammation, 1 non-necrotising granulomatous inflammation, 1 small cell lung cancer, 1 pauci-cellular, 2 pleural plaques. Follow up at 6 months, the diagnosis did not change in the 80% with pleural tissue obtained at biopsy (32/40). Out of the 20% (8/40) who did not have a diagnostic sample, on further testing: 2 had TB, 1 mesothelioma and 1 lymphoma. One patient with inflammatory pleuritis went on to have a VATS biopsy, but the diagnosis did not change. One patient did not have follow-up data. Two are still under follow up to confirm benign disease. There were no complications in any of the patients directly from the procedure. In conclusion, we believe image guided pleural biopsy by a pleural specialist nurse can add value to the patient’s diagnostic pathway and management. However, in our experience, there is a steep learning curve and there needs to be appropriate supervision and safety checks in place.