Cope Needle Pleural Biopsy: Is There a Place for This Procedure in Video-Thoracoscopy Times?
Thiago Bachichi, MD; Caio Holanda, MD; Luiz Eduardo Leão, PhD; João Aléssio Perfeito, PhD; José Ernesto Succi, MD; Erika Rymkiewicz, MD; André Miotto, MD
INTRODUCTION: Pleural biopsy is the standard diagnostic tool when exploring pleural effusion and thickening. Cope needle biopsy was classically the first choice method for diagnostic search. Needle pleural methods for obtaining pleural tissue were been used since the second half of nineteenth century and with around 50% accuracy could be achieved, mainly for malignancy. In current times, direct vision tissue obtained under video-thoracoscopy allows precise diagnosis, but an operating room and general anesthesia are necessary.
CASE PRESENTATION: Twenty nine patients were studied regarding its sensitivity as the etiologic diagnosis. The biopsies were performed between November 2013 and December 2014 in the Division of Thoracic Surgery of EPM/UNIFESP/HSP. This study included all patients with exsudative pleural effusion without definite diagnosis. Patients where pleural empyema was suspected and patients with pleural drainage were excluded. All procedures were performed by thoracic surgery residents. Procedures were performed bedside when in hospital, and in a simple procedure room in outpatient cases. Pleural fluid was collected for biochemical, cytological and citopatological evaluation. Puncture site for the Cope needle was the posterior region of the hemithorax below the angle of the scapula; procedure was performed under local anesthesia. Three or four pleural specimens were obtained for each patients and all tissue was sent for pathologic studies.
DISCUSSION: Among the 29 patients where pleural biopsies were performed as an initial method, in 12 patients (41.3%) it was possible to reach diagnosis; when pleural fluid analysis was included, 15 patients (51.7%) a diagnosis was achieved. In a third of all diagnosed cases (5 patients) the diagnosis was tuberculosis; another five had secondary pleural malignancy and in remaining five had pleural fibrosis and reactive pleuritis. There were no complications related to the procedure. room in outpatient cases. Pleural fluid was collected for biochemical, cytological and citopatological evaluation. Puncture site for the Cope needle was the posterior region of the hemithorax below the angle of the scapula; procedure was performed under local anesthesia. Three or four pleural specimens were obtained for each patients and all tissue was sent for pathologic studies.
CONCLUSIONS: We conclude that pleural biopsy with Cope needle may still have a place in medical practice as an inexpensive, simple and low morbidity method. Of course, image-directed biopsies when available and thoracoscopy should always be considered; however, in this study in a general hospital, where this procedure performed by thoracic surgeons in training, this simple method achieved precise diagnosis is more than half patients before any further diagnostic tool. We believe this method can avoid more complex and expensive procedures. gical evaluation. Puncture site for the Cope needle was the posterior region of the hemithorax below the angle of the scapula; procedure was performed under local anesthesia. Three or four pleural specimens were obtained for each patients and all tissue was sent for pathologic studies.
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DISCLOSURE: The following authors have nothing to disclose: Thiago Bachichi, Caio Holanda, Luiz Eduardo Leão, João Aléssio Perfeito, José Ernesto Succi, Erika Rymkiewicz, André Miotto
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