Chest Department,AssiutUniversity,Assiut,Egypt

Abstract Purpose: Encouraging positive diagnosticyieldsin malignantpleuraleffusion couldbeobtainedbypleuralbrushingperformedthroughtwotechniques,thefirstwasclosedandthesecondwasthoracoscopic.Untilnowtheultrasoundguidedpleuralbrushingisnotincludedwithinthesetechniquesanditsdiagnosticyield therefore is notevaluated.Sotheaim of thisstudywasto evaluatethe diagnosticyield of
thisprocedureanditscontributionsasatechniquenotusedpreviouslyintheinterventionalpulmonologypracticetoobtainpleuralspecimenforcytologicalexaminationinmalignantpleuraleffusion.Methods:ThisprospectiveinterventionalstudywasconductedintheChestDepartment–AssiutUniversityHospitalduringtheperiod from July2014to September2015.Patientswhohadhighlysuspiciousmalignantpleural effusion(clinical,radiological,andlaboratory)werehospitalizedandenrolledinthisstudy.Patientswithbleedingtendencyorcoagulationprofileabnormalitieswereexcludedfromthestudy.Patientswerealsoexcludedfromthisstudyiftheetiologyofeffusionwasprovedtobebenign.Informedwrittenconsentwasobtainedfromallpatients.Theequipmentusedinourstudywereultrasoundapparatus(ALOKA–Prosound–SSD–3500SV),biopsyforceps(KARL–STORZ–Germany10329L–BS),thebronchoscopiccleaningbrush(PENTAX CS6002SN) trocar andcannula of Cope’sneedle and the semirigidthoracoscope(LTF; Olympus;Tokyo,Japan).Thoracentesis,pleuralbrushingandbiopsyforcepsofthepleurawereperformedforallenrolledpatientsintheultrasoundunitoftheChestDepartmentwhilethoracoscopywasdoneintheendoscopyunitonlyforpatientsinwhomthediagnosiscouldnotbeachievedbytheseprocedures.Results:Among22patientswhowerefinallydocumentedtohavemalignancy,theultrasoundguidedpleuralbrushingprovideddiagnosisin9(41%)/22cases,itwasexclusivelydiagnosticin3patients.Interestingly,theyieldof thisprocedurehad its contributionsregardingthefinalpathologicaldiagnosisof ourcases,itcouldaugmentthepositiveyieldtobe55%insteadof41%(forpleuralfluidcytologyalone),82%insteadof68%(forbiopsyforcepsalone)and86%insteadof72%(forbothfluidcytologyandforcepsbiopsy).Therecordedcomplicationsinourstudywereminimalandnotassociatedwithanymortality.Conclusions:Ultrasound-guidedpleuralbrushingisanewmethodforobtainingpleuralspecimens.Itisasimpleandrelativelysafeprocedure.Thistechniqueprovidesadditionaldiagnosticyieldin malignantpleuraleffusion.Werecommend itbesideothersin our diagnosticpracticeforsuspiciousmalignanteffusionespeciallywhenthoracoscopy is notavailable.