Revista Clínica Española (English Edition) Revista Clínica Española (English Edition)
Rev Clin Esp 2017;217:420-2 - Vol. 217 Num.7 DOI: 10.1016/j.rceng.2017.02.007
For and Against
The case for performing pleural biopsies for the aetiological diagnosis of exudates. Yes
¿Se debe realizar una biopsia pleural para el diagnóstico etiológico de los exudados? Sí
F. Rodriguez-Panaderoa,b,
a Unidad Médico-Quirúrgica de Enfermedades Respiratorias (UMQER), Hospital Universitario Virgen del Rocío, Sevilla, Spain
b Laboratorio de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain
Received 10 February 2017, Accepted 18 February 2017

Pleural biopsies are especially indicated in the following circumstances: (a) inconclusive pleural fluid analysis and negative sputum study, if adenosine deaminase (ADA) levels are unavailable; (b) suspected multi-resistant tuberculosis; (c) a need for differentiating tuberculous pleurisy (if it progresses with neutrophilia) and complicated parapneumonic effusion; (d) malignant pleural effusion coexisting with very high ADA levels; (e) effusion coexisting with lung cancer and negative pleural cytology; (f) suspected mesothelioma; and (g) need for implementing re-treatment for patients with relapse after chemotherapy. Image-guided needle biopsy is recommended for cases a and b, while thoracoscopy is preferable for the other cases.


La biopsia pleural está especialmente indicada en las siguientes circunstancias: a) análisis del líquido pleural no concluyente y estudio de esputos negativo, si no se dispone de adenosina-desaminasa (ADA); b) sospecha de tuberculosis multirresistente; c) necesidad de distinguir entre pleuritis tuberculosa (si cursa con neutrofilia) y derrame paraneumónico complicado; d) derrame pleural maligno coexistiendo con ADA muy elevada; e) derrame coexistiendo con cáncer de pulmón y con citología pleural negativa; f) sospecha de mesotelioma, y g) necesidad de aplicar retratamiento en pacientes con recaída tras quimioterapia. Es recomendable hacer biopsia con aguja guiada por técnicas de imagen en a) y b), y sería preferible hacer toracoscopia en el resto de las situaciones.

Pleural biopsy, Malignant pleural effusion, Tuberculous pleurisy, Thoracoscopy
Palabras clave
Biopsia pleural, Derrame pleural maligno, Pleuritis tuberculosa, Toracoscopia


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Rev Clin Esp 2017;217:420-2 - Vol. 217 Num.7 DOI: 10.1016/j.rceng.2017.02.007
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