Closed needle pleural biopsy: A victim of western advancement?

Sir,

Hira and Ranjan reaffirmed the importance of closed needle pleural biopsy in the diagnosis of pleural pathology.[1] With the emergence of thoracoscopy, the use of closed lung biopsy has declined significantly, especially in the developed world. Some western councils even no longer require competence in performing the lung biopsy by pulmonary and critical care fellows for their accreditation.[2] No doubt thoracoscopy has shown better results in the diagnosis of pleural malignancy, but the role of pleural biopsy in the diagnosis of tubercular pleural effusion, which is a much greater problem in India, is as good as thoracoscopy.[3] It is highly relevant in our resource-limited, tuberculosis prevalent country where thoracoscopy and CT-guided FNAC are available only in major hospitals of big cities. Discouragement of closed pleural biopsy by western literature unfortunately translated into its decline in India too. We need to redeem the practice and art of closed pleural biopsy among Indian pulmonologists through proper awareness and encouragement.