CHEST Guidelines-Response_chest

Response_chest - 4

Pdf Summary

The document comprises two letters to the editor responding to findings on the microbiological yield of pleural biopsy specimens in diagnosing tubercular pleural effusions, and the use of pleural biopsies in bacterial pleural infections.<br /><br />The first letter by Drs. Thangakunam and Christopher from Christian Medical College discusses their experience using ultrasound-guided pleural biopsies compared to the use of the Xpert MTB/RIF assay, a molecular test for diagnosing tuberculosis (TB). Their data showed that pleural tissue obtained during a biopsy had a much higher microbiological yield than pleural fluid alone for diagnosing tuberculosis in pleural effusions. In one study, thoracoscopic pleural biopsy showed an even higher yield, with Xpert and Mycobacterium tuberculosis culture positivity at 45% and 39% respectively, markedly surpassing the yield from pleural fluid at 14% and 17%. They also suggest that thoracoscopic biopsies, though more technically demanding, might also improve outcomes in bacterial pleural infections due to better sample yield and facilitation of treatments.<br /><br />The second letter, penned by Ioannis Psallidas and Najib Rahman from Oxford's Centre for Respiratory Medicine, responds specifically to the AUDIO study on ultrasound-guided pleural biopsies. Their results confirmed that ultrasound-guided biopsies significantly enhance the microbiological diagnostic yield over traditional techniques for bacterial pleural infections. They acknowledge the potential for thoracoscopy to provide larger biopsy specimens, thereby enhancing diagnostic capability even further.<br /><br />The document also briefly mentions the use of endobronchial ultrasound (EBUS) in managing acute pulmonary embolism (PE) in critically ill patients, highlighting a case where EBUS helped to guide critical treatment decisions without requiring patient transport to a CT scanner, which could pose risks given the patient's instability.

Keywords

pleural biopsy

tubercular pleural effusions

ultrasound-guided biopsy

Xpert MTB/RIF assay

thoracoscopic biopsy

microbiological yield

bacterial pleural infections

endobronchial ultrasound

pulmonary embolism

diagnostic capability