Comparative study between medical thoracoscopic and ultrasound-guided transthoracic pleural biopsies in diagnosis of tuberculous pleural effusion

Abstract Background Tuberculosis (TB) is a multisystemic disease caused by Mycobacterium tuberculosis. Extrapulmonary TB can occur as part of a primary or late, generalized infection. Tuberculous pleurisy is the second most common extrapulmonary tuberculosis. Objectives The objective of this study is to assess and compare the diagnostic efficacy of medical thoracoscopic and ultrasound-guided transthoracic pleural biopsies in the diagnosis of tuberculous pleural effusion (TPE). Methods This is a prospective randomized clinical study of 30 patients suspected of having TPE based on clinical, radiological, and laboratory data and referred for diagnosis. All the patients were randomized into two groups. Group A underwent medical thoracoscopy, while Group B underwent ultrasound-guided transthoracic needle biopsies. Biopsy specimens were subjected to histopathological and microbiological analysis. Patients in group B with inconclusive results underwent subsequent medical thoracoscopy. Results After exclusion of non-tuberculous pleural effusion cases, 24 TPE cases were diagnosed. Medical thoracoscopy was able to diagnose 12 out of 13 cases (92.3%) while ultrasound-guided transthoracic needle biopsy, diagnosed 12 out of 14 cases (85.7%). No statistically significant difference was seen between two procedures ( P = 1.00). Conclusion No statistically significant difference is detected in the diagnostic yield of medical thoracoscopy and ultrasound-guided transthoracic needle biopsy in diagnosis of TPE. We suggest ultrasound-guided biopsy for patients suspected of having TPE, as it is less invasive and requires rapid bedside intervention.