Actinomicosis broncopulmonar: simuladora de cáncer de pulmón / Bronchopulmonary Actinomycosis Mimicking Lung Cancer

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Biopsia pleural con aguja Tru-cut y citología como primer procedimiento en el estudio del derrame pleural / Tru-Cut Needle Pleural Biopsy and Cytology As the Initial Procedure in the Evaluation of Pleural Effusion

Introducción y objetivos: El estudio del derrame pleural (DP) incluye distintas técnicas, como la biopsia pleural (BP). Los objetivos han sido analizar la rentabilidad diagnóstica de la BP con aguja Tru-cut (BPTC) y determinar si existen factores clínico-radiológicos que permitan indicar la realización de la BPTC como primer procedimiento. Metodología: Estudio retrospectivo de las BPTC de un centro hospitalario (2010-2012). Se excluyeron casos de lesiones pleurales sin DP. Se analizaron variables clínico-radiológicas, la rentabilidad diagnóstica, las complicaciones de la BPTC y los factores asociados con la rentabilidad diagnóstica de la combinación de la BPTC y toracocentesis como primer procedimiento. Resultados: Se revisaron 127 BPTC; el 29,1% fueron DP malignos y en el 18,9% no se llegó a la causa del DP. La rentabilidad diagnóstica de la BPTC para tuberculosis fue del 76,5% (13/17) y para DP malignos, del 54% (20/37). Hubo un 4,7% de complicaciones. En 72 pacientes con diagnóstico final conocido, la BPTC se hizo simultáneamente a la primera toracocentesis. La rentabilidad diagnóstica de la combinación de BPTC/citología como primera técnica fue del 43% (31/72) frente al 12,5% (9/72) de la citología sola (p = 0,01). La única variable predictora para la indicación de BPTC como técnica inicial fue la cuantía del DP > 2/3 (p = 0,04). Conclusiones: La BPTC es segura y ha demostrado una rentabilidad diagnóstica aceptable, sobre todo cuando se combina con la citología simultánea en el estudio del DP de diferentes etiologías. La aplicación de criterios radiológicos podría ayudar a seleccionar en qué pacientes podría estar indicada como primera técnica inicial junto a la toracocentesis

Introduction and objectives: The evaluation of pleural effusion (PE) includes various techniques, including pleural biopsy (PB). Our aim was to study the diagnostic yield of Tru-Cut needle PB (TCPB) and to define clinical/radiological situations in which TCPB might be indicated as an initial procedure. Methodology: Retrospective study of TCPB in a hospital center (2010-2012). Cases of pleural lesions without effusion were excluded. Clinical and radiological variables, diagnostic yield, TCPB complications and factors associated with the diagnostic yield of the combination of TCPB and thoracocentesis as initial procedure were analyzed. Results: One hundred and twenty-seven (127) TCPB were reviewed: 29.1% were cases of malignant PE and in 18.9% the cause of the PE could not be determined. The diagnostic yield of TCPB for tuberculosis was 76.5% (13/17) and 54% (20/37) for malignant PE. Complications occurred in 4.7% of the cases. In 72 patients with a final definitive diagnosis, TCPB was performed at the same time as the initial thoracocentesis. Diagnostic yield for the combination of TCPB/cytology as an initial technique was 43% (31/72) compared to 12.5% (9/72) for cytology only (P = 0.01). The only predictive variable for the indication of TCBP as an initial technique was a PE volume > 2/3 (P = 0.04). Conclusions: TCPB is safe and provides an acceptable diagnostic yield, particularly when combined with simultaneous cytology in the evaluation of PE of various aetiologies. Radiological criteria may help guide the selection of patients who could benefit from this technique as an initial procedure combined with thoracocentesis

Tru-cut needle pleural biopsy and cytology as the initial procedure in the evaluation of pleural effusion.

INTRODUCTION AND OBJECTIVES: The evaluation of pleural effusion (PE) includes various techniques, including pleural biopsy (PB). Our aim was to study the diagnostic yield of Tru-Cut needle PB (TCPB) and to define clinical/radiological situations in which TCPB might be indicated as an initial procedure. METHODOLOGY: Retrospective study of TCPB in a hospital centre (2010-2012). Cases of pleural lesions without effusion were excluded. Clinical and radiological variables, diagnostic yield, TCPB complications and factors associated with the diagnostic yield of the combination of TCPB and thoracocentesis as initial procedure were analysed. RESULTS: One hundred and twenty-seven (127) TCPB were reviewed: 29.1% were cases of malignant PE and in 18.9% the cause of the PE could not be determined. The diagnostic yield of TCPB for tuberculosis was 76.5% (13/17) and 54% (20/37) for malignant PE. Complications occurred in 4.7% of the cases. In 72 patients with a final definitive diagnosis, TCPB was performed at the same time as the initial thoracocentesis. Diagnostic yield for the combination of TCPB/cytology as an initial technique was 43% (31/72) compared to 12.5% (9/72) for cytology only (p=0.01). The only predictive variable for the indication of TCBP as an initial technique was a PE volume>2/3 (P=.04). CONCLUSIONS: TCPB is safe and provides an acceptable diagnostic yield, particularly when combined with simultaneous cytology in the evaluation of PE of various aetiologies. Radiological criteria may help guide the selection of patients who could benefit from this technique as an initial procedure combined with thoracocentesis.