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Abstract

Objective: To compare diagnostic yield between pleural fluid cell block and pleural biopsy by Pleuroscopy.
Methods: This prospective study was conducted at the Pulmonology Department, Mayo Hospital Lahore. Patients with exudative pleural effusion from December 2020 to December 2022 who underwent Pleuroscopy at the Pulmonology Department were included in the study. Pleuroscopy was performed under local anaesthesia; pleural fluid was collected for a cell block, and then multiple pleural biopsies were taken.
Results: Thirty patients with exudative pleural effusion were enrolled in the study. Final diagnosis was 16 adenocarcinoma, 2 small cell carcinoma, 1 squamous cell carcinoma, 5 malignant pleural mesothelioma (MPM), 3 no malignancy, 2 metastatic carcinoma, 1 caseating granuloma. Diagnostic yield by pleural biopsy in comparison to cell block was found to be significantly higher [90% (27/30) vs. 70% (21/30); p = 0.008].  Nine patients with negative cell block had positive results on pleural biopsy (1 diffuse large B cell lymphoma,1 metastatic small cell carcinoma,1 mesothelioma,4 adenocarcinoma,1 metastasis malignancy). Three patients had inconclusive evidence for malignancy on both pleuroscopy and cell block.
Conclusion: Cellblock can be used as an initial, less invasive diagnostic test for the workup of suspected pleural effusion. It can be easily performed on pleural fluid during thoracentesis, and treatment can be initiated in case of positive cell block reports without the need for pleuroscopy in every patient with suspected malignant pleural effusion. However, Pleuroscopy can be subsequently performed in patients with a negative cell block.