Pleural biopsy: a negative result did not rule out malignancy or tuberculosis.

Clinical bottom line (level 4)

  1. A positive pleural biopsy made malignancy or tuberculosis much more likely (LR+69) .
  2. A negative pleural biopsy made malignancy or tuberculosis slightly less likely (LR-0.33) .
Poe et al: Archives of Internal Medicine 1984; 144: 325-328
Expires October 2003

The study

Setting: three acute hospitals, USA

211 patients (aged range 14 to 97 years; mean 64, 54% male) having pleural biopsy

Excluded if
  • no pleural tissue could be identified in biopsy specimen
  • died before cause of effusion found, or not available for follow-up



    • ?independent unblinded reference standard, applied in all patients from a consecutive ?appropriate spectrum.
    Reference standard:
    • final diagnosis based on hospital and physician records at 12 to 72 months after admission
    Diagnostic test: pleural biopsy (using a Cope or Abram's needle). Positive if evidence of malignancy or tuberculosis. Non-specific results were considered negative if target disorder was excluded by an additional open biopsy, post-mortem or subsequent clinical course that was inconsistent with either disease

    The evidence

    pre-test probability of malignancy: 48%, (95% CI: 41% to 55%)

    diagnostic test malignancy or TB no malignancy or TB LR+
    (95% CI)    		 post-test probability LR-
    (95% CI)    		 post-test probability
    positive pleural biopsy 63 1 69
    (9.8 to 490)     		98% 0.33
    (0.24 to 0.44)     		23%
    total 93 102

    Comments

    1. It is unclear if non-specific results that failed to meet additional criteria were considered positive or negative.

    Citation

    1. Poe RH, Israel RH, Utell MJ, et al: sensitivity, specificity and predictive values of closed pleural biopsy. Archives of Internal Medicine 1984; 144: 325-328
    Search Terms: reference from Pleural effusion chapter in 'Quick Consult Manual to Evidence-based Medicine': publd. Lippincott-Raven, 1997
    Contributor: Chris Ball and Clare Wotton, October 2000
    Reviewer:

    Clinical Question.
    Patient patients
    Intervention or Exposure having pleural biopsy
    Outcome diagnosis of malignancy or tuberculosis