Histopathological diagnoses on pleural biopsy specimens at Chris Hani Baragwanath Academic Hospital over a 15-year period: A retrospective review

Abstract

Background Pleural effusions are a common reason for presentation to health care facilities. The clinicians’ approach to the investigation of exudative pleural effusions often requires pleural biopsies. Blind closed pleural biopsy can be a useful tool, especially in resource-limited settings to diagnose the cause of exudative pleural effusions. Objectives To determine the variety, frequency and change in profile of histopathological diagnoses of closed pleural biopsies at Chris Hani Baragwanath Academic Hospital over the period from 1st January 2001 to 31st December 2015. Methods A retrospective review of pleural biopsies performed on patients from 1st January 2001 to 31st December 2015 at Chris Hani Baragwanath Academic Hospital were examined by the Department of Anatomical Pathology at the National Health Laboratory service. Patients’ age, gender, HIV status and histopathological diagnosis were obtained from two databases (DISA and TrakCare). Results A total of 1 013 samples were included in the study. The most common diagnosis was granulomatous inflammation in 48% (n=375), with the most common type being necrotizing granulomatous inflammation in 73.8% (n=276). Ten percent (n=78) of biopsies showed malignancy, most commonly adenocarcinoma, with 46% (n=36) metastatic and 23% (n=18) primary lung adenocarcinoma. The odds of being V

diagnosed with malignancy showed increasing statistical significance above the age of 40 years: 40-49 years (OR 8.7, 95% CI 1.1-66.9, p=0.038), 50-59 years (OR 12.4, 95% CI 1.6-95.0, p=0.015), 60 years and greater (OR 23.0, 95% CI 3.1-171.3, p=0.002). The odds of being diagnosed with malignancy in this study was greater in HIV negative patients (OR 0.5 95 CI 0.2-1.0, p=0.040), with greater odds of a “non cancer” diagnosis in HIV positive patients (including granulomatous inflammation and pleuritis (OR 2.16, 95% CI 1.03-4.51, p=0.040)). Conclusion Blind closed pleural biopsy has a role to play in the diagnosis of exudative pleural effusions in resource-limited settings, particularly for patients suspected to have tuberculosis or malignancy. Tuberculosis remains a common cause of exudative pleural effusions. Patients with an exudative pleural effusion (in whom the diagnosis is not obvious by other means) should have a pleural biopsy performed. Sampling technique is important to obtain specimens of adequate quality for assessment. There was a high frequency of inadequate specimens noted in this study suggesting that further training in pleural biopsy technique may be of benefit.