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. 2025 Apr 18;26(1):153.
doi: 10.1186/s12931-025-03229-2.

Impact of pleural thickness on the sensitivity of computed tomography scan-guided cutting-needle pleural biopsy in diagnosing unexplained exudative pleural effusion

Rui Xu #  1 , Ling Zuo #  1 , Chiyong Yang  2 , Li Jiang  3 , Ying Liu  4 , Ping Fan  5 , Kaige Wang  6 , Dan Liu  7
Affiliations

Impact of pleural thickness on the sensitivity of computed tomography scan-guided cutting-needle pleural biopsy in diagnosing unexplained exudative pleural effusion

Rui Xu et al. Respir Res. .

Abstract

Background: In most cases, patients with pleural effusion require a pleural biopsy to confirm the diagnosis, due to the low diagnostic sensitivity of thoracentesis. Among the different biopsy modalities, real time computed tomography scan-guided cutting-needle pleural biopsy (CT-CNPB) ensures high sensitivity and accessibility. However, there is no study investigating the difference in the diagnostic sensitivity of CT-CNPB for lesions with variable pleural thickness in effusions of different types.

Methods: Of the 303 patients who underwent CT-CNPB, 218 met the eligibility criteria and were retrospectively analyzed from November 2021 to June 2024. Patients were divided into malignant pleural effusion (MPE), tuberculosis pleural effusion (TPE), and non-tuberculous benign pleural effusion (BPE) groups according to the diagnosis with a minimum follow-up of 6 months. Pleural thickness was defined as the length of the portion of the puncture needle that passes through the thickened parietal pleura or the pleural lesion (nodule/mass). In further analysis, we compare the differences in sensitivity between subgroups with different pleural thicknesses in each group.

Results: The overall diagnostic sensitivity is 74.3%. The sensitivity in MPE, TPE, and BPE is 75.7%, 78.6%, and 67.8%, respectively. There was a significant difference in sensitivity between the < 5 mm and ≥ 5 mm groups in MPE and BPE groups but was not observed in the TPE group. In the further analysis, there was a significant difference in sensitivity between < 3 mm and 3-5 mm groups in TPE (p = 0.046) and a significant difference in sensitivity between 3 and 5 mm and 5-10 mm groups in MPE (p = 0.017), but a significant difference was not observed in BPE group.

Conclusion: CT-CNPB may serve as a preferred diagnostic approach in suspected TPE with pleural thickening ≥ 3 mm and suspected MPE with thickening ≥ 5 mm on chest CT. Where MT is unavailable, CT-CNPB is a viable alternative for suspected MPE or TPE patients with pleural thickening, nodularity, or mass lesions observed on CT. However, in suspected BPE, CT-CNPB alone is often insufficient; integrated clinical, laboratory, and imaging evaluation remains essential.

Keywords: Diagnosis; Exudative pleural effusion; Real time computed tomography scan-guided cutting-needle pleural biopsy.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was performed in accordance with the declaration of Helsinki and was approved by the ethic committee of the West China Hospital of Sichuan University (No. 2024 − 1582). Written informed consent was waived approved by the ethic committee of the West China Hospital of Sichuan University due to the retrospective noninterventional design. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests. Clinical trial number: Not applicable.

Figures

Fig. 1
Fig. 1
Flowchart of the study screening and grouping
Fig. 2
Fig. 2
Real time computed tomography scan-guided cutting-needle pleural biopsy imaging, the red arrows indicate the entry sites. A, CT imaging of a patient who was subsequently confirmed tuberculosis pleural effusion, with a pleural thickness of 7 mm. B, CT imaging of a patient who was subsequently confirmed malignant pleural effusion, with a pleural mass of 10 mm. C, CT imaging of a patient who was subsequently confirmed tuberculosis pleural effusion, with a pleural thickness of 2 mm
Fig. 3
Fig. 3
Diagnostic sensitivity of different pleural thickness subgroups in different types of pleural effusion
See this image and copyright information in PMC

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