Samrina Sadaf, Sumera Kazmi, Amina Noor, Mohammad Yasin, Uzair Noor, Nimra Kanwal.
The utility of pleural biopsy in differentiating between different types of lymphocytic exudative pleural effusions.
Pak J Chest Med Jan ;27(1):32-6.

Background: A great majority of patients present to outpatient clinics with pleural effusion in Pakistan and throughout the world. Till date more than fifty causes of pleural effusion have been identified. Among 22% remained undiagnosed despite intensive investigations. The most common causes of lymphocytic exudative pleural effusion are tuberculosis and malignancy. Pleural biopsy examination is considered an important investigation for the diagnosis of exudative effusions. The aim of this study was to evaluate ability of pleural biopsy to differentiate between different exudative pleural effusions with lymphocytic predominance. Methodology: This cross-sectional descriptive study was conducted in Pulmonology unit, Ayub Teaching Hospital, Abbottabad from 12th October, 2017 to 20th May, 2018. Patients 13-90 years of age group of both genders, who presented with lymphocytic exudative pleural effusion diagnosed on pleural aspiration, were included in the study. A total of 126 patients were included in the study. Consecutive non probability sampling was used. Patients with transudative pleural effusion, those on diuretic therapy, bleeding diathesis and patients unwilling for the procedure were excluded from the study. Results: Out of 126 patients,71were males and 55 were females. In 114/126 (90.4%) patients an adequate pleural tissue were obtained. Out of those 76 (60.3%) were having granulomatous inflammatory changes presumptive of tuberculosis, 38 (30.2%) patients had malignancy and 12 (9.5%) had nonspecific results. When pleural biopsy was stratified with age and gender, there was statistically significant association with age with p value of<0.02 but no statistically significant association with gender with p value>0.02. Conclusion: The most common causes of lymphocytic exudative pleural effusion are tuberculosis and cancer. Tuberculosis is more common in children and adolescents, whereas cancer is more common in adults. In patients with unidentified exudative lymphocytic pleural effusion, pleural biopsy should be a regular diagnostic technique.

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